Tuesday, May 27, 2008

It's no LOL: Few US doctors answer e-mails

I came across this article a week or so ago. It's no LOL: Few US doctors answer e-mails from patients | ajc.com

I am really intrigued with this area of the medical management process. I love email as a mean of communicating and receiving information. I find I am more thoughtful about how I am communicating I am always surprised, that something that would seem like such a time saver, from the patient POV, would not be embraced by doctor's. It seems like such a no brainer. I have read there are security issues.... patient confidentiality challenges, and . While I can understand, I think it ultimately comes down to the fear factor of patient liability issues.

I am wondering what other people think about this issue. Please share your thoughts.


Anonymous said...

Regarding doctors and e-mail I offer my opinion as a person with chronic illness and experience similar to yours, and also as a person who has worked on the provider side of medical care.

First is the matter of e-mail itself and how sloppily it is used and that even the most thoughtful of communicators leave themselves wide open to misunderstanding absent tone of voice, body language, facial expressions, etc. This is because e-mail itself is primarily a verbal communication in written form. Thus, the formalities of 'good' writing are dropped. The potential for miscommunication on something as important as your health make the stakes too high not just from a liability standpoint but a conscience standpoint. Imagine living with the consequences of a serious mistake because even though you are a doctor, writing is not your best skill. Tone of voice is one of the most diffcult skills to master in writing -even professionals (writers) struggle with this one.Tone of voice is essential to understanding. Using varied inflections and tone of voice, how many different ways can you interpret the statement: Billy is coming to the party. Oh boy. You should be able to speak that and mean several different things, some positive and others not so much.

Then there is the possibility that you are not communicating with the patient herself but her nosy relative. E-mail does not readily provide authentication/verification that you are talking to who you think you are. I mean, who are you talking to right now? Who am I? I realize we're on a blog but you get the picture.

Lastly there is the matter of logistics. Say your doctor has 1000 patients and 10% (or #100) e-mail you on a given day asking questions that don't involve yes or no answers. Imagine answering 100 e-mails a day in a truly thoughtful fashion -every one of them carrying liability, possibly career-ending liability, in addition to seeing pts for 8 hours, responding to contact from pharmacies, imaging centers, labs, your partners in practice, other physicians, your hospital of affiliation, administration and maybe even your own family and friends. All this in addition to dealing with office staff,etc.; not to mention that the acceptable error rate in the practice of medicine is 0% and by virtue of the fact that medicine is a human endeavor 0% is unattainable. So you know you're going to make mistakes. The only variable is what mistakes will those be. Opening oneself up to a medium even less perfect in terms of understanding than the telephone and other current methods of communication is very risky in an area where there is no acceptable risk. You must also remember that if you are not rare, writers who can articulate themselves as well as you are certainly not the majority. If you need to verify this take a truly random walk through cyberspace or the blogosphere. Let yourself happen onto the comments section of articles ranging from topics as varied as those about decisions from the hockey commissioner to Dancing With the Stars. All of those folks who show up as semi-literate at best receive medical care, too. (All of said commenters are not semi-literate but there are enough to make my point.) Also, e-mail eliminates the gate-keeping aspect of other forms of communication which is truly important to the management of a physician's time. Your shortness of breath, for example, may be priority one to you but if the doctor is dealing with a dying young patient and her family on that particular day how will you feel if you receive no reply and no explanation? Every pt calling a doctor feels his or her problem to be urgent. But without the big picture you may be doing better than anyone else so you get pushed to the bottom. The potential for hard feelings and real damage to the dr-pt relationship is high there, too. It could be a public relations mightmare if you're not gifted or even fond of e-mail. Every doctor has at least one patient who would either e-mail them every day, or every 15 minutes on any given day when that pt would not make the same number of calls to the office. It is not about whether the physician is caring and attentive; it is about a very real need for priority setting and time management. (All of the above does not deny the existence of, or excuse the behavior of those physicians who are truly arrogant bastards with the bedside manner of a stone.)

The numbers of how many people might want to e-mail one individual doctor make it too lopsided to be practical at this point. It is basically the same as why we cannot e-mail, personally, the President, Prime Minister or celebrities, depending on where you are -on a smaller scale, but the same concept.

Alex said...

Wow, thanks for the comment. I use email as a mechanism to provide basic updates for a non local doctor and deal with scheduling issues. I can see from what you are saying how it can be abused.

Mea said...

Good post.

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