The Trouble with Physician Email

There are many articles on why physicians won’t use email to communicate with patients, such as the lack of remuneration, liability fears, HIPAA concerns and time constraints[1,2,3]. The fact is, physicians don’t read their email or respond to anyone. Seriously. Here’s a typical scenario: as physician champion for the EHR in our local system I hold once monthly sessions to trade tips & tricks and answer questions. Doctors rarely show up. Recently one of the physicians emailed me a recommendation that he thought would be of benefit to the providers (I was excited to get an email from him). “Why don’t you hold a monthly tip & trick session and everyone could share?” Wow. What a great idea. How come I never thought of that? After seething for a good five minutes I sent back an email and said “I’ve been offering this for almost a year now. Obviously I’m not communicating it well enough to the doctors since the email announcement several days before each session isn’t working. Do you have any suggestions on how to improve my communication?” The returned response was, “I guess I don’t read my emails very often.” You think?

The same week my manager got an email from our PR department requesting her to tell me something. When I inquired as to why they didn’t send the email directly to me their response was “Because doctors never read their emails.” Fair enough. But I do. 

Yes, writing this rant in a blog is singing to the choir. If you read blogs I’ll bet you keep your email correspondence up-to-date, but seriously doctors: YOU HAVE TO READ YOUR EMAILS in this day and age. It is part of your job. To those of you who are tasked to communicate with physicians, even if they don’t read their emails, it is your job to send them. Don’t remove responsibility from the doctors’ shoulders by never sending the information to begin with. You can copy the manager but you still have to email the doctor.

Our inboxes are crammed full of unimportant things so get the friendly IT guy to create filters for you. Fewer irrelevant things will be delivered to your inbox. Don’t feel the need to respond to every email. Most people don’t need to be thanked or even acknowledged, and they don’t want more extraneous emails in their inbox either. Establish a “throw away” email address on Google or elsewhere to give out when you buy something. Unsubscribe to sites that send you stuff. For more in-depth writing on the subject I recommend the Asian Efficiency website, especially this guide on emails.

OK, back to my inbox. There is probably some mail I need to respond to.

1. Weill Cornell Medical College. The Doctor Will Email You Now
3. Wall Street Journal January 23, 2012  Should Physicians Use email to Communicate with their Patients?

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To email or not to email…

Using email to communicate with patients is controversial both inside and outside of medicine. Not only have recent articles in medical literature addressed this but the Wall Street Journal published a very recent Yes/No opinion discussion on it. There are multiple issues involved–security, HIPAA compliance (which can involve hefty fines if one is found non-compliant), ensuring that patients understand the parameters for email use, concerns about liability, and time constraints among the biggest that come to mind.

The AMA has published guidelines for physicians that want to use email in their practice. Most of them are common sense suggestions but some are burdensome and difficult to communicate during an already foreshortened visit thanks to the time constraints most doctors have in practice. For instance, I am supposed to “Request that patients put their name and patient identification number in the body of the message.” My patients have no clue what their identification number is. I could request their date of birth but at this point they get my email address from my staff or from my business card and there are only five or six people who utilize it. I do print all communication out (since I don’t yet have an Electronic Medical Record) and so far I have had no trouble identifying who I’m talking to…Another recommendation is “Instruct patients to put the category of transaction in the subject line of the message for filtering: prescription, appointment, medical advice, billing question.” With only a very few people out of my population of 3000 are asking for this type of communication, it’s ludicrous to create a strict policy with emails.

It is amusing that the development of these guidelines was prompted by request of the Young Physicians Section of the AMA in 2000 (and it hasn’t been updated since 2002). It’s amusing because “young” people these days hate email. They use social media, eschewing email as much as possible. That’s a topic for another day but I understand that point of view. Email is cumbersome by contrast to Facebook messaging or texts even though it is more professional.  Also of interest is a separate publication by the AMA on the Ethical Use of Email with patients. Also very common sense kind of recommendations but I venture to guess most physicians have no idea this advice is on the AMA site.

So what’s my feeling on using email? Well, as I mentioned above, I don’t use it with very many people so at this point it is not a big issue. I find that the majority of individuals do not abuse the privilege and have short, to-the-point messages requesting refills or clarification of some minor medical question. The patients are in all ranges of ages, from early twenties to mid-seventies. If the question is too lengthy, I ask them to make an appointment. As mentioned above, I print out almost all emails and put them in their paper charts (what’s wrong with that remark!) Emails do not take the place of phone calls because I reserve phone calls for more lengthy explanations of lab results or other tests where I need to be sure the patient understands what I am saying. Really bad news is only given in person, so that’s not an issue. So far it’s been a helpful supportive tool. It is possible that I’ll change my mind as things evolve, or perhaps a social media site will take the place of email entirely. 

In the meantime, those patients who do utilize email to communicate with me really seem to appreciate the opportunity and don’t abuse it. It seems like another good tool for bettering patient communication and that’s a plus.

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