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Doctor's Inbox Is Now More Outgoing

E-mail communications good for prescriptions and referrals, study shows

WEDNESDAY, May 8, 2002 (HealthDayNews) -- Many doctors avoid using e-mail with their patients, afraid they will be deluged with requests and plagued with long-winded medical versions of Portnoy's Complaint.

Yet, a recent study shows patients use e-mail wisely and sparingly, for more practical needs such as referrals and prescriptions.

"The biggest concern of physicians was that the e-mails would cover too much ground and be too complex," says study author Dr. Steven Katz, an associate professor in the departments of Medicine and Health Management at the University of Michigan. "But this turned out not to be the case."

One hundred-and-twenty faculty members and residents at the University of Michigan participated in a trial of a new e-mail system designed to assess and respond to patient messages. More than 1,600 e-mail requests were sampled in a nine-month period. The results were presented at thsi week's meeting of the Society of General Medicine in Atlanta.

The study shows that 27 percent of patients use e-mail to give short updates on their condition, 18 percent to renew prescriptions, 10 percent to ask for referral, and 5 percent to inquire about recent lab tests. Only 9 percent asked a specific question about their health.

"Health-care administrators assume they will get flooded with 10,000 messages a day," Katz says. "Our study suggests that patients will gradually start using this approach, and that it won't put a huge burden on providers."

"It took me only 15 to 20 minutes a day to answer e-mails," says Dr. Steve Gradwohl, an assistant clinical professor of medicine who participated in the study. "That's less time than I spend returning phone calls."

Not all patients are e-mail users. Older patients who have more serious illnesses still prefer to stop by the office or check in by phone. Overall, the e-mail group was younger, healthier and better educated, Katz says.

"They're going to depend on e-mail communication with their doctors as they age," he adds.

The Michigan study was also designed to assess some of the most common barriers in doctor-patient communication.

"Patients are frustrated as they try to navigate our complex medical system," Katz says. "At some clinics, you can get stuck on hold and never get through the right person. The e-mail study was a marvelous opportunity to create a new communication system, and to address the concerns about service and efficiency associated with managed care."

Patients in the University of Michigan health-care system logged on to the system's Web site and were told what to expect from e-mail communication. They were also educated about its appropriate uses.

Only one doctor got spammed by a patient -- he received an e-mail called, "What to do if you lose your wallet." Doctors were relieved when they were not put on joke lists, did not start receiving mail from porn sites, and did not contract computer viruses, Katz says.

Patients did worry that their messages would be ignored or lost. However, they were also pleasantly surprised. Their messages were screened by a nurse, who fielded their questions to the appropriate doctor. All were answered within two days.

Web-based systems are the next step in patient-doctor communication because they're more secure, the researchers say.

"With the usual e-mail connection, doctors and patients assume they are having an intimate conversation. But this material isn't encrypted, and anyone could hack into it," Katz says.

In the University of Michigan study, one group used regular e-mail and the other had access to a specially designed system -- The Electronic Message and Information Link (EMAIL) -- which boasted a secure server, password protection and encryption technology. The system was built in collaboration with McKesson Information Solutions and Intel Corp.

The EMAIL system received nearly five times the number of messages as the regular control group.

If you want to e-mail your doctor, simply ask for an e-mail address.

"We found that many doctors just don't think to give it out," Katz says.

Be sure to use e-mail for daily concerns, not medical emergencies.

"One patient sent me a message at two in the morning, saying he had chest pains and was short of breath. Luckily, it turned out not to be a heart attack," says Gradwohl, adding this exchange was not part of the study. "I tell my patients to call my pager or dial 911 if it's something serious."

What To Do

To check out a sample of a secure, online doctor-patient program, go to the University of Michigan.

Read this Harvard article on online doctor-patient relationships.

SOURCES: Steven Katz, associate professor, departments of Medicine and Health Management, University of Michigan, Ann Arbor; Steve Gradwohl, assistant clinical professor, medicine, University of Michigan, Ann Arbor; May 4, 2002, presentation, Society of General Medicine meeting, Atlanta
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