Sunday, November 22, 2015

Is E-mailing with Patients a Good Idea?

Physicians speak with patients every day on the phone for a variety of reasons.   Our practice now uses a portal system, giving patients access to some of their medical data and to us.  Although I was resistant to having e-mail communications with patients, I have come to appreciate the advantages.

  • It relieves our ever congested phone lines
  • It relieves patients from a state of suspended animation as they hope and pray that a living breathing human being will return to the line after being placed on hold
  • It saves our staff time who no longer have to triage calls as the patient directly reaches the doctor

While this streamlined cyber communication system is useful, it does have limitations.  It can’t solve every problem.  Indeed, some issues are not appropriate for either a phone call or an e-mail.

Calling his doctor?

Consider the following scenarios.  Which can be appropriately handled on the phone and which merit a face to face encounter with a physician?

  • I was in the emergency room yesterday and they told me to call you for pain medicine.
  • My diverticulitis is acting up and I need an antibiotic.
  • My breathing is worse.  I think it’s a side-effect of the new heart medicine I started last week.
  • What can I take for constipation?
  • My cousin had the same symptoms and it ended of being her gallbladder.  Can you give me the name of a surgeon?
  • I’m dizzy and my hemorrhoids have been bleeding for a week.  What can I take?
  • I have hepatitis C.  Is is okay if my grandchildren visit?
  • I had some chest pain yesterday when I was shoveling snow.  Should I double my Nexium?

The practice of  medicine is not fully wireless, at least not yet.  Sure, e-mail is convenient for everyone, but if used too casually it can become quicksand.  Often, the patient feels an e-mail is sufficient, but the physician may not be comfortable, depending upon the medical facts and how well the doctor knows this patient.  When you are face to face with your doctor, the medical history will be more detailed, there may be a physical examination, and there will be a dialogue and review of treatment options.  It’s a lot easier for us to assess your pain, for example, when you are in front of us.  Moreover, when you return to see us for a follow-up visit, we have a baseline to use as a comparison.

What are your thoughts on all this?   Feel free to e-mail me, but I’d prefer if you came to see me
face to face.


  1. Many of the scenarios that you presented, the answer depends upon the pre-existing relationship with the patient. Some are obviously not appropriate.

    It really doesn't matter, though. The powers to be have decided that e-mail access must be a part of meaningful use stage 3. Meaningful use is setting us up for greater heartburn and liability. For example, the dizzy hemorrhoid patient who e-mailed: the e-mail is missed or not attended to for several hours, and then they die of a massive MI because not mentioned in the e-mail, they have cardiac disease status post CABG 2 weeks ago and they were dizzy because their hemoglobin was 8.5 and they were a-fib with RVR. I am assuming that we will all have to disclaimer e-mails sent out immediately stating he time period in which to anticipate a response, ER warnings for worsening symptoms etc., etc., etc.

  2. why the auto reply will read like the first sentence of the message when calling a hospital doctors office or such

    or better yet to send an email you'll need to be logged into the secured provider that will have you accept the terms such that this is and emergency do not send the email but log off and call 911.......

  3. The company that owns the portal used by my orthopedist now emails me with marketing materials, thinking that I am a physician. All attempts to get them to stop and remove my name from the portal have failed. I refuse to use any and all portals henceforth. They are so undeniably, irrefutably hackable that there is absolutely no semblance of privacy. I pity the poor physician, who may hoisted by his own petard.