Thursday, December 18, 2008
To email or not to email
In a response to an ACP Internist article about patient web portals, we recently asked InternistWeekly subscribers whether they communicate with patients online. The results showed that our readers (or at least those who responded to the survey) are ahead of the curve with patient email: 38% said they communicate with patients online, and another 19% are interested in the idea. The remaining 43% said "No, and I'd like to keep it that way."
As a follow-up, the survey asked why the respondents do or don't use online communication. Not surprisingly, the answers revealed time, technology and money to be the biggest hurdles to implementation. Many readers saw no reason to mess with the status quo and add potential complications with HIPPA, encrypted email or malpractice risk. "The phone works fine and actually talking to a patient is far preferable to email," a commenter said. Or as one succinct doc put it, "Think it would double my workload."
Another saw a wide range of risks inherent in emailing: "Increases risk of misunderstanding and potentially increases liability. Increases tendency to carry out 'telephone' medicine with the lack of hands on, visual, and intuitive clues to the real underlying problem. It is time-consuming in aggregate and adds to an already overloaded schedule. There is no evidence that engaging in this type of communication will improve medical care or decision making, reduce liability, reduce workloads or increase income."
The physicians who do use email would likely disagree with that reader. Several mentioned that they limit their online communication to brief messages, like sending test results or setting up appointments. Listed benefits were the ease of communication, avoidance of phone tag, and savings on postage. And then there was the most unusual reason for using email: "It also intimidates enough people to not pursue silly things." Perhaps a selling point that EMR vendors will want to add to their pitches.
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Labels: patient communication
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Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.
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Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).
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Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
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Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.
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Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.
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Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
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