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


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

In This Article


Of 172 registered participants, 100 patients (58%) completed all questionnaires and were included in the data analyses (67 in the e-mail group, and 33 in the control group). All 8 physicians completed their time logs and questionnaires.

The patient characteristics for both e-mail and control groups were similar ( Table 2 ). The e-mail group was slightly younger, with 42% under age 50 vs 21% in the control group. There was equal distribution for the age-group older than 65 and for sex. On average, patients had been in the practice for more than 8 years. Three quarters of the patients had completed at least a college education. Most found it easy to use e-mail, and nearly 50% spent 1 to 10 hours per week on the computer. They used the Internet for health information (58% e-mail group, 70% control group), entertainment (32% e-mail, 49% control), news (32% e-mail, 70% control), business/finance (44% e-mail, 58% control), and shopping (46% e-mail, 52% control).

Patients. Patients in this study were generally very satisfied with the communication with their doctors at the time of entry into the study, rating most items in the questionnaire 4 or higher on a 5-point scale. However, 2 items showed a statistically significant difference between groups during the study. The level of satisfaction significantly increased in the e-mail group, compared with the control group in the areas of convenience of communicating with their physician ( F = 8.29; P < .0001), as shown in Figure 1, and the amount of time spent contacting their physician ( F = 7.84; P < .0001), Figure 2.

Patient satisfaction with the convenience of contacting doctor ( P < .0001).

Patient satisfaction with the amount of time spent to contact doctor ( P < .0001).

Physicians. Physicians in both the e-mail and the control groups were generally dissatisfied with the practice's message system, rating it less than 3 on a 5-point scale. Given the few physicians in the study, changes in the level of physician satisfaction across time were not statistically significant; there were, however, some notable trends that seemed to correlate with the patients' responses. Over the 6-month study period, physicians in the e-mail group seemed to have increased their satisfaction ratings in the message system in the areas of convenience, amount of time spent on messages, and volume of messages. They consistently rated their satisfaction higher than the non-e-mail physician group. These possible trends could be better studied using a larger physician sample. There were no significant changes in the number of messages during the study between the 2 groups either by self-reporting ( F = 0.65; P = .42) ( Table 3 ) or by the data gathered by the clinic secretaries ( F = 2.71; P = .10). This suggests that perhaps the increased satisfaction may be the result of improved convenience or quality of communicating with patients.

During the 3 selected weeks when all phone messages were collected for the study, 732 messages with complete information were available for data analyses (329 from the e-mail group and 406 from the control group). Over the study period, 299 emails were received from patients in the e-mail group. For all messages, we analyzed the categories, response time, and time required to address messages.

Categories. Of the phone messages, 270 (37%) were in the categories of administrative (referral, forms completion), 199 (27%) were on questions related to medical condition/consult, and 145 (20%) were on issues related to medications (refill, side effects, instruction on taking medication). A smaller number of messages were related to test results and/or were informational (update of conditions, sharing of information) ( Table 4 ). E-mail messages included 95 (32%) informational, 93 (31%) on medical conditions/consult, 48 (16%) on medication, 43 (14%) administrative, and 20 (6.7%) on test results.

Response Time. Of all the completed messages, 180 e-mail messages and 340 phone messages had sufficient data to calculate the time it took for the messages to be addressed by the physicians. Most phone messages (284 [83.5%]) were answered in the same day. The response time was longer with e-mail; 68 (38%) were answered in the same day, 53 (29%) in 1 day, and 28 (15.5%) in 2 days ( Table 4 ). This may be the result of several factors. It is the practice's policy to address phone messages from patients the same day. Phone messages in general are more acute in nature, requiring more urgent attention. There is no policy on e-mail response time because it is not the usual mode of communication for the practice. Patients in the study were advised to use e-mail for only nonurgent messages and that a reply might take 2 to 3 working days. Because there was a separate account for patient e-mail, one physician experienced some difficulties remembering to check that account for messages. In addition, it was not possible to access the account off-campus.

Time Required to Address Messages. During the same 3 selected weeks, the physicians also tracked the number of messages received and reported the time spent addressing messages ( Table 3 ). There was great variation in the volume of messages reported by physicians: 15 to 103 per week in the e-mail group and 21 to 72 per week in the control group. Likewise, physicians differed in the time they took to address messages, from an average of 12 to 62 minutes per day and 2 to 5.5 minutes per message. This variation occurred in both the e-mail and control groups. All but 2 physicians had fewer messages in the third week of the study. Over the study period, 299 emails were received from patients in the e-mail group. Similar to the non-e-mail messages, the volume of messages and the time spent addressing these messages differed from one physician to another. Based on self-reported data, most physicians took less time to address e-mail messages (1 to 3 minutes per message).

Once informed of the http://www.familydoctor.org web site, 97% of the patients visited the site at least once. In the beginning of the study, most of the patients found the web site very useful, but nearly 50% rated it only somewhat useful by the end of the study.

At the conclusion of the study, all patients and physicians were asked, "Should patients be able to e-mail their doctors?" All patients in the e-mail group and 97% in the non-e-mail group responded yes to this question. The physicians were less uniform in their answers. All 4 physicians in the e-mail group, but only 2 of the 4 in the non-e-mail group, answered affirmatively. Most patients in the study would like to e-mail physicians; 90% in the e-mail group and 86% in the non-e-mail group would use it for prescription refills, and 39% in the e-mail group and 19% in the non-e-mail group would like to use it for scheduling appointments.

Of the written comments received on the questionnaires, 40% (33 of 83) were comments praising e-mail as a convenient and efficient method of communication. The patients enjoyed being able to give a quick update on their conditions to their physicians or ask questions regarding referrals. Eleven patients expressed frustration when calling the office, citing the long hold time and phone "tag." One patient in the non-e-mail group wrote a lengthy letter urging the institution to provide e-mail access for all patients. Only 2 patients expressed concern over privacy issues.


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