February 25, 2009
2 min read
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Do you use e-mail to communicate with patients?

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POINT

One must strike a fine balance between e-mail and visits

Ronald Tamler, MD
Ronald Tamler

When I first started practicing, I remember e-mail was something special. Today, patients expect direct access to their physician in the day of the Blackberry. E-mail is regarded as an informal medium, and some patients either address me inappropriately or write about personal matters that have nothing to do with why they are seeing me. A patient may not make an office appointment because there is nothing to discuss in person if they’ve already received an answer by e-mail. Patients do not realize that the physician is providing a service for free with e-mail, time that could be otherwise spent seeing a patient.

The question is: How does a physician manage that without being taken advantage of? The best piece of advice is to not let e-mail run your life and to find a way to correspond with patients that will not hurt your professional or personal life. One has to be very selective as to how much time is allocated to e-mailing patients and which topics are discussed.

I use e-mail with my patients because it is timely and everything is in writing — when I start seeing patients who are interested in e-mailing me, I make them aware that any e-mail correspondence may find its way into their chart. I answer e-mail during office hours when I’m sitting in front of my computer; if an e-mail pops up then, I will answer it reasonably quickly. After hours, even if I see the e-mail, I will not answer if it’s a request that can wait, such as a refill. For urgent matters, I encourage patients to call the office, since the answering service knows to page the doctor on call.

Ronald Tamler, MD, is an Assistant Professor of Medicine in the Division of Endocrinology at Mount Sinai Medical Center and Associate Editor of PRESENT Diabetes.

COUNTER

Instant care anywhere

Peter Libby, MD
Peter Libby

The internet provides a very potent tool for communicating with patients. However, it is also a double-edged sword.

Physicians must be concerned about issues of documentation, confidentiality and abuse of access. We need to recognize that e-mail must be executed with all the care with which we speak to a patient and their family face-to-face and annotate the medical record.

Almost all of the e-mails I get from patients are appropriate. Seldom have I been stalked by e-mail, but we do need to devise, as a community, appropriate ways to limit occasional occurrences of abuse of access by individual patients. With respect to non-patient-related e-mails, we all probably spend more time than we can to pruning spam. Instant availability to everyone has a downside.

I stay in touch with patients on three different continents using e-mail. It’s a really great way for my private panel of patients to get care in different places, as I can communicate with their local doctors by e-mail.

Again, it is a mixed blessing that gives you the impression that you are in touch with people much more readily than if they had to make an appointment or reach you by telephone.

Peter Libby, MD, is Chief of Cardiovascular Medicine at Brigham & Women’s Hospital and Mallinckrodt Professor of Medicine, Harvard Medical School. Read Dr. Libby’s online postings at the New York Times: consults.blogs.nytimes.com.