Why Doctors Don't Email Patients
Wednesday, April 23, 2008
Joshua Schwimmer, MD, FACP, FASN
Image via WikipediaIt's no secret that I'm a strong advocate of patient physician communication by email. (See, for example, "Does Providing Email to Patients Benefit Patient-Physician Communication," "Someone Please Create Free, HIPAA-Compliant Patient-Physician Email," and the three part "Thoughts on Patient Physician Email.")The Associated Press published a story recently with the following title: It's no LOL: Few US doctors answer e-mails from patients.
Kreuziger’s experience is shared by most Americans: They want the convenience of e-mail for non-urgent medical issues, but fewer than a third of U.S. doctors use e-mail to communicate with patients, according to recent physician surveys.I'm surprised that almost a third of doctors emailed their patients, frankly. I would have suspected the number would be lower.
“People are able to file their taxes online, buy and sell household goods, and manage their financial accounts,” said Susannah Fox of the Pew Internet & American Life Project. “The health care industry seems to be lagging behind other industries.”
Doctors have their reasons for not hitting the reply button more often. Some worry it will increase their workload, and most physicians don’t get reimbursed for it by insurance companies. Others fear hackers could compromise patient privacy _ even though doctors who do e-mail generally do it through password-protected Web sites.
There are also concerns that patients will send urgent messages that don’t get answered promptly. And any snafu raises the specter of legal liability.
Many patients would like to use e-mail for routine matters such as asking for a prescription refill, getting lab results or scheduling a visit. Doing so, they say, would help avoid phone tag or taking time off work to come in for a minor problem.
Still, a survey conducted early last year by Manhattan Research found that only 31 percent of doctors e-mailed their patients in the first quarter of 2007...
The article goes on to say that Cigna and Aetna have piloted programs which pay doctors for making "virtual house calls" through email. This is a step in the right direction. Dr. Robert Center points out that the lack of payment has been a major barrier to more widespread adoption of patient-physician email.
As I write repeatedly, physicians are not paid for their time, they are paid by the widget. The patient visit is our version of the widget. Anything that we do to prepare for that visit, communicate between visits, review the tests induced by that visit or discuss you problem with another physician is gratis. We cannot bill for the proper use of time to improve the patient experience.For further reading on patient-physician email, see
- Email: The new frontier in physician-patient communication? and
- Why you should email your patients in Modern Medicine
Labels: E-mail, Health care, Physician
4 Comments:
At Thu Apr 24, 07:04:00 PM 2008,
Anonymous said…
Doctors do not use email with patient because of all the security restrictions they face with the use of emails. I am a physician, and would really like to use email for administrative purposes. We do not however because of HIPAA and other security concerns. I cannot just use my email account to send mail to my patients aol or yahoo accounts for this reason. In order to use email, doctors need to use portal based messaging (such as RelayHealth") of a secure email system. This unfortunately complicates the adoption process, and as a result, few doctors end upmusing email.
At Mon Apr 28, 06:46:00 AM 2008,
Huck said…
I essentially have two patients that I email.
We have a set up at our institution to allow for secure email. HIPPA is a pain, and I have to explain the rules of email (don't email me telling me you are having crushing substernal chest pressure), but for the two patients that use email, it has enhanced their care and streamlined my ability to deliver it.
At some point in the future, as more patients and doctors get used to email, there needs to be some form of billing component so that a) your inbox won't have 1000 emails and b) it will deal realistically with the incoming demand.
At Fri Dec 26, 07:28:00 PM 2008,
Norman said…
its clear that everyone wants this. Patients are willing to pay for it, and doctors would do it if the email were secure and they could get reimbursed for it. The problem has been that there wasn't a convenient way of doing that. Housedoc.us however, allows for both. Makes the process much easier.
At Fri May 01, 04:49:00 PM 2009,
Anonymous said…
One part propaganda five parts rubbish. These defenses are utterly disingenuous. The reason doctors don’t want email is that the don’t want clear statements of fact that can not later be denied. In cases of malpractice it’s much more convenient for a doctor to deny a patient said this or that. It’s much easier to obfuscate facts by sticking to a cryptic patient’s chart. ALL lawyers know perfectly well why doctors don’t want email and it has NOTHING to do with the patient’s best interest but the best legal interests of the doctor as a CYA measure. When doctors adopt such a policy they put THEIR interests above the patients best interests and ergo breach their fiduciary duty to their patients.
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