Previously I have blogged about the impact of doctor-patient communication on reducing health care costs . When it comes to contacting a doctor outside of the office, communication tends to fall apart; traditionally patients will call their doctor’s office and are directed through an answering service that will subsequently get in touch with the doctor. In rare cases I know of physicians or dentists providing their patients with direct access via pager or phone number. During my training I was always intrigued by the doctors that provided patients with direct access, especially the docs that gave out their home number, because I assumed patients were constantly calling or paging them 24 hrs a day. However, most patients are not comfortable directly contacting their doctor unless it’s a true emergency (in which case their doctor wanted to be the first to know anyway). In fact many of my mentors stated that they gave patients direct access as a comforting tool and were rarely if ever contacted directly.
It is from this experience that I found this paper from the Archives of Surgery so interesting. Dr. Stalberg et al from the University of Sydney in Australia found that providing patients e-mail access to their surgeon improved communication between patient and surgeon. 100 patients undergoing elective surgery were randomized to either receive a pre-operative information sheet promoting e-mail communication with their doctor versus a standard information sheet. Many doctors are concerned with providing patients e-mail access due to worries of abuse. This study actually indirectly gives insight into the potential for patient abuse of e-mail access. There was more communication between surgeon and patient in the e-mail group but only 38% of those patients contacted their doctor, this was compared to 14% of patients contacting their doctor from the standard group. This is a significant increase in doctor-patient communication, but this is not an abuse of e-mail access when one considers these patients were mostly looking to address one issue regarding their surgery rather than using e-mail as a way to ask an overwhelming number of questions. Few doctors would argue against the small investment in time communicating with patients over e-mail if it meant that patients better understood their post-operative care or the medications they are taking. Good communication between doctor and patient limits the misunderstandings that can lead to improper post-operative care or the misuse of medications that force patients to seek emergency care. A couple of extra hours a week leisurely responding to e-mails are better than spending those hours rushing to the emergency room in the middle of the night.
The major issue against e-mails however is the lack of security. It is hardly appropriate to answer patient inquiries between responding to friends or family. Electronic doctor-patient interactions have to be secure, which is why with SavvyDoc we have created an internal messaging system for doctors and patients to interact with each other. In this way patients can feel comfortable communicating with their doctor without fear of that correspondence being in an insecure format. Doctors have the added benefit of separating the business of taking care of patients from the rest of their lives.