Well, here I am. Again. On vacation and connected to the internet. I must admit, I am addicted. Twitter, blogging, and email. I cannot seem to just let it go–not even for a week. Email, in particular, seems to have taken a dominating role in all of our lives. Constant hip checks for email downloads to our iphones have become an obsession. As we speak, I am on a beautiful 4 hour train ride from Edinburgh to London (the same route that Harry Potter and his friends take from Hogwarts, no less).
This week on the website Inc.com, I came across an interesting article that explores the ways in which email is ruining our health. A group of UK researchers decided to examine the effect of email on a group of workers. Objective measures such as blood pressure, heart rate and cortisol levels were measured and the workers also kept a log of their work activities during the study period. Results of the study indicated that a single email was no more stressful than taking a single phone call–however, an inbox full of a large amount of email produced a powerful stress reaction with elevations in cortisol, heart rate and blood pressure. Interestingly, the study did find that the type of email received had a significant effect on stress. Email that was received about current activities and contained time relevant information as well as emails that congratulated a “job well done” were not at all stressful. in contrast, emails that were completely irrelevant and interrupted tasks were incredibly stressful and levels of cortisol, blood pressure and heart rate all spiked. The lead researcher, Dr Tom Jackson, concluded that the email itself is not the issue–it is how the email is used that causes the problems with increased stress. We are managing email in the midst of phone calls, family time, and other in person meetings. Often, responding to and filtering through email can be a distractor and take us away from more important tasks. Hence–email is stressing us all out.
As I mentioned, I am currently on “holiday” in the United Kingdom with my family. I have tried very hard not to use email but I have failed miserably. For me, the act of checking email twice a day has lowered my levels of anxiety about work. However, when I stumbled upon certain email messages my levels of stress began to spike. These were often emails that I could do nothing about until I return to the states. (As with most folks, feelings of loss of control and the inability to respond also create elevated levels of stress). Luckily, I have my family with me on our tour through the UK to set me straight–instead of fretting over the emails and how to handle them, I was “convinced” to take a walk to Edinburgh castle and enjoyed a nice day in the sun (It may have been the only sunny day in Scotland this year). My family and I had a wonderful day together in the castle.
I think that, in reality, one must find a balance between connectivity and relaxation. For each person this balance is going to be different and based on individual personality traits. I enjoy blogging and it is a very relaxing, stress reducing activity for me. As I have mentioned in a previous blog, writing allows me to process my thoughts and share my feelings. (Hence this blog is being written over the course of a four hour train ride). For others, a completely disconnected holiday is the best course. Whatever it may be, find your own balance. Understand that email is an important tool for productivity and that it can be abused. For me, I am learning what types of emails tend to elevate my own cortisol levels and will attempt to avoid these emails on future vacations. Life work balance is essential to success and longevity–finding your own balance with email and connectivity is a critical component to this process. With that, I am going to sign off and stare out the window at the beautiful Scottish wind blown sheep.
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.