Few Doctors Are Web M.D.'s

- USAToday
February 05, 2007

In a world where most people routinely e-mail friends, family and colleagues, and many exchange e-mail with teachers, newspaper columnists and even the pizza delivery guy, it's a weird fact: Most of us still don't have e-mail relationships with our doctors.

For a decade, experts in medicine and technology have been saying that patient/doctor e-mailing was an obvious trend just waiting to explode. But studies show a very slow adoption of the practice: Just 8% of adults said they had received e-mail from their doctors in an online survey in 2005 by Harris Interactive for The Wall Street Journal Online.

Although 25% of doctors said they communicated online with patients in a survey last year by Manhattan Research, other studies suggest a smaller number do so regularly.

Medicine "has been astonishingly behind the rest of the world," says Debra Roter, a researcher who studies doctor/patient communication at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

"There has been a lot more talk than action about everything 'e' in medicine," says Daniel Sands, a practicing Boston internist and assistant professor at Harvard Medical School who also works for the technology company Cisco Systems.

Most experts say doctors, rather than patients, have dragged their feet, for several reasons. In short, doctors worry that:

•Patient confidentiality will be compromised in messages sent over the Internet.

•Doctors will be deluged by patient e-mail, which would add hours of uncompensated labor to their work weeks.

•Patients will send e-mail about urgent matters — for, example, heart attack or stroke symptoms — that doctors won't see in time.

But, one by one, those objections are being answered by a combination of technology and experience. The technology includes secure websites that doctors or health care organizations can set up to handle e-mail and, often, full electronic medical records — another trend that has caught on more slowly than expected.

Meanwhile, some insurers are experimenting with online systems that charge patients a small fee for each e-mail consultation or one yearly fee for e-mail access. (Researchers disagree on whether this will deter use.)

Horror stories never materialized

Just as important, though, may be that doctors are finding that e-mail nightmares rarely come true.

"Patients are much more careful about using e-mail than we thought they would be," and most doctors get a handful of perfectly appropriate messages every day, says Kate Christensen, medical director of KP.org, a secure website used by 600,000 members of managed-care giant Kaiser Permanente.

And patients like it. Doris Taylor, 69, a retired nurse who sees Kaiser internist Lisa Liu in Sacramento, says: "To me it saves a lot of time. You can get right to the point."

Liu says she finds e-mail efficient, too. "It's the patient's own words, coming straight to me," she says, not a phone message scribbled by a third party. She has been surprised to find that e-mail also helps build relationships: "Now that we have the ability to touch base between visits, I feel more connected."

'I would love to see more doctors try this'

Jenni Prokopy, a Chicago writer who founded www.ChronicBabe.com, a website for young women with chronic illnesses, says her internist just started taking e-mail. She says she does not miss playing phone tag with him. E-mail, she says, produces "a more immediate and personal response" and just makes sense for people who spend their days online.

"I would love to see more doctors try this," she says.

Will they? The experts keep saying yes, and soon.

"We've reached the tipping point," Roter says. "I think it's really going to happen now."

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