Enhancing Doctor-Patient Communication Using Email: A Pilot Study

Shou Ling Leong, MD; Dennis Gingrich, MD; Peter R. Lewis, MD; David T. Mauger, PhD; John H. George, PhD

Disclosures

J Am Board Fam Med. 2005;18(3):180-188. 

In This Article

Abstract and Introduction

Background: The doctor-patient relationship has been eroded by many factors. Would e-mail enhance communication and address some of the barriers inherent to our medical practices?
Methods: Of our study population, 4 physicians offered e-mail communication to participating patients and 4 did not. Both patients and physicians completed questionnaires regarding satisfaction, perceived quality, convenience, and promptness of the communication.
Results: Patient satisfaction significantly increased in the e-mail group compared with the control group in the areas of convenience ( P < .0001) and the amount of time spent contacting their physician ( P < .0001). Physician satisfaction in the e-mail group increased regarding convenience, amount of time spent on messages, and volume of messages. The response time was longer with e-mail. When asked if patients should be able to e-mail their physicians, most patients in the e-mail group and all but 2 of the physicians in the non-e-mail group responded "yes."
Conclusion: E-mail communication was found to be a more convenient form of communication. Satisfaction by both patients and physicians improved in the e-mail group. The volume of messages and the time spent answering messages for the e-mail group physicians was not increased. E-mail has the potential to improve the doctor-patient relationship as a result of better communication.

Effective communication between patients and doctors has always been the hallmark of a mutually beneficial doctor-patient relationship, contributing to improved clinical outcomes and high rates of patient and physician satisfaction. New technology can dramatically change that communication, from the invention of the telephone in 1876 to the more recent electronic mail (e-mail). These technologies revolutionize doctor and patient contact, with potential benefits tempered by concerns including privacy, security, and unwanted daily intrusions.[1,2]

Internet use is increasing dramatically and many individuals are using e-mail to communicate with family or friends about health issues.[3,4,5] In one study by Neill et al, 85% of patients believed e-mail "would be a good way for a patient to communicate with his/her physician."[6] Another study suggested that roughly one half of the patients in 2 large primary care centers used e-mail, but only 10.5% had ever used e-mail to communicate with a physician.[7] However, 70% of these patients indicated a willingness to use e-mail communication with their physician. In a survey of primary care physicians in Boston, 75% of physicians reported using e-mail with patients, but only with a small subset (5% or less) of their overall patient population.[8]

When patients e-mail their physicians, the purpose is primarily for prescription refills, nonurgent consultations, and to obtain laboratory test results.[9] Physicians' responses to these e-mail communications range from no reply to providing detailed information.[10] This emerging technology, with its variable application to and impact on the doctor-patient relationship, has prompted the American Medical Association to produce the "Guidelines for Patient-Physician Electronic Mail."[11]

Benefits and risks associated with using e-mail communication have been identified.[12,13,14,15,16,17,18,19] Rapid, inexpensive, simple, convenient, and asynchronous communication are distinct benefits that could result in a reduction in the number of nonurgent telephone calls to the office, an increase in patient participation in medical decision-making, and an improved linkage to patient education materials.[20] Concerns about privacy and security, inappropriate use for acute serious illnesses, potential for increased physician workload, and legal liability are serious limitations. Physician concerns regarding time consumption, however, may be overstated.[21,22] Patient concerns regarding e-mail communication include routing the message to the right person, length of time for a response, and privacy issues.[7]

Despite these concerns, e-mail communication between patients and their physicians is likely to increase and may result in a reconfiguration of physician office function.[23,24,25,26] Therefore, further assessment of patient and physician satisfaction with e-mail communication is indicated. In this article, we report on a 6-month assessment of patient and physician e-mail communication focusing on the following aspects of this interaction:

  • Patient and physician satisfaction

  • Perception of convenience

  • Turnaround time for physician response

  • Volume of messages received from patients

  • Types of messages

  • Physician time requirement to address messages

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