Embracing Technology and Providing Care: The Role of Email and Texting in the Patient Encounter

As we become more connected as a society, it is inevitable that healthcare moves toward more of a virtual online presence as well.  Telemedicine and remote follow up is becoming more common.  I have previously blogged on the importance of the “personal” face to face office visit but at the same time, I embrace the digital revolution in healthcare.  Finding the proper balance is the key to successful integration of technology into the delivery of effective healthcare in today’s changing world.

Recently, an article in the Wall Street Journal addressed the controversies surrounding the use of email communication between doctor and patient.  This practice is fraught with significant legal, personal and professional issues.  Patients certainly deserve prompt answers to their questions and reasonable access to their providers–but should we as physicians be accessible via email 24 hours a day?  The WSJ piece profiles a few physicians and highlights the way in which each uses email to communicate with patients.  Based on recent national surveys, it appears that currently nearly 30% of physicians communicate via email to their patients.  Nearly 18% actually used text messaging to interact with patients.  Estimates suggest that only 5% of American patients included in the survey use email or text to communicate with their physicians or other healthcare providers.

So what are the advantages of email communication?  Physician proponents of electronic communication cite the ease of interaction and the avoidance of “phone tag”.  In addition, physicians who email say that it actually saves them time in the office visit because rather than having to deal with misinformation that patients have obtained via google searches about a particular condition, they are able to provide accurate medical answers when the patient wants them via virtual communication.  Moreover, these advocates also say that the “good will” and positive ratings that are afforded them by patients who are particularly pleased with email access helps them compete in crowded medical markets such as seen in Manhattan in New York City.

Others see electronic communication with patients as problematic.  Obviously there are significant issues with privacy, security and miscommunication of important medical instructions or advice.  In addition, there may be major legal implications when providing access via email or text.  For example, if you provide email and text access to your patients, are you responsible for responding immediately on a weekend or holiday?  If the patient suffers a major negative health event, are you responsible if you did not respond.  I am certain throngs of litigators are licking their chops at this new frontier of frivolous malpractice claims.  Certainly, allowing access during time at home with family and during weekends and holidays may even further reduce a physician’s “down time” and reduce the quality of time spent with family and friends.  With workloads increasing and time away becoming scarce, burnout rates are as high as ever and this type of 24-7 connectivity may lead to even quicker flame outs.  Other physicians cite concerns over reimbursement–time spent emailing and texting patients is unpaid.  With reimbursements falling yet again, providing free services just doesn’t make sense to many providers’ bottom line.

Technology such as email and text can be an incredibly powerful tool in medicine.  I communicate with colleagues and with consultants routinely in this manner.  Departmental business can be easily handled via email communications.  Although many patients certainly enjoy the convenience and speed of email and text access to their physicians, I am not sure the medical system is ready for this interaction at this time.  We must define parameters for these interaction and come up with professional guidelines.  We must ensure that patients remain safe and do not replace important office follow up visits with virtual communications.  In addition, a method for compensating physicians for the time spent in electronic communication must be defined and incorporated into current reimbursement policies.  The trial lawyers must be prevented from taking advantage of the numerous pitfalls associated with email and text communications.  For privacy reasons, we must ensure that messages are encrypted and for medical-legal reasons we must create a way for email and text communications to be downloaded into the electronic medical record in order to fully document all doctor patient interactions that occur.  The digital revolution in medicine has begun–it is going to change the way we do business–it is essential that we guide its development in ways that positively impact outcomes and improve quality of care.


2 responses to “Embracing Technology and Providing Care: The Role of Email and Texting in the Patient Encounter

  1. Deborah Fisher

    Dr Campbell provides am important alternative view of this emerging topic. In my medical setting there is an optional secure electronic portal for electronic communication between patients and providers. In addition, there are clear expectations for response time and an established process for coverage. The method for crediting providers for the time it takes to respond is less established. Nonetheless, unlike some scenarios exemplified in the WSJ article, the essential issues of privacy, security, accountability, and patient and provider responsibility have at least been considered.

  2. Hi Dr. Campbell. Can I get your feedback on something that is about this exact topic, communication.
    I have been going to a hemonc clinic to receive my iron infusions for a few years now. The Crohn’s makes me anemic and I can’t take oral iron, so IV iron is the route I have to take.
    Recently, right before moving from my dads house, I started to feel anemic.. I was badly anemic. HGL was i think 7 or something. I had so much to do with little oxygen to my brain to get stuff done and very little help and support from family. I asked for a blood transfusion and explained to them that I was movig and needed energy NOW, not in a week or 2. It takes a little while for the iron to convert to RBC ya know? Transfusion – instant… In addition I wouldn’t need to commute an hr for the 6 infusions. It would be 1 which I expressed to them for only this 1 time. They said no to the transfusion. I made 3 commutes to get the infusions of iron and cancelled the rest because I just couldn’t do it physically. I ended up missing the follow up appointment w/ my Dr. that they do after the infusions to check my levels as well. They don’t call my cell phone ever and they send letters. SNAIL F’ING MAIL! And they had been sent to my fathers house. 1 of the letters is CERTIFIED. You know what that means. I havent even opened it yet because I know what it most likely says.. They are discontinuing my care.

    I like my Dr. there and I need my Iron infusions. Before I moved in to my dads I met with the social worker there because mentally I wasn’t in a good place. Most of the mental distress is the rejection from family. I finally got out of my dads house (it was TOXIC living there.. he became verbally abusive and it just was necessary for a move). Unfortunately, I neglected my health and didnt get the other 3 infusions because I just couldn’t! That was why I requested the blood transfusion this 1 time because I knew I wouldnt be able to do everything I had to do plus the infusions.

    I was thinking of calling the social worker there.. I dont know. If they dropped me it’s because they have a different reason in mind. Like im just blowing off appointments. Not true. What do I do?
    Any advice would be greatly appreciated… Thank You

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