Friday, October 06, 2006

E-mail Blues

People seemed amazed that doctors don't use e-mail. Well, we do. But this doctor prefers NOT to use it for direct patient care. Why?

Because I can't check it 24/7/365. I do procedures. Some last hours in duration. Or I might be gone for the weekend - and guess what - some places I go do not have Internet access! I had one time early in my career and earlier in the days of e-mail that made me pause.

He was a young man with hypertrophic cardiomyopathy (a genetic disorder that caused his heart muscle to the thickened and prone to potential life-threatening arrhythmias) discovered on a routine physical exam while he (and I) was in the Navy. One day, unbeknownst to me, he nearly fainted while taking a drink from a water fountain. It was innocent enough, he thought. But he decided to drop me an e-mail and mentioned the experience. I didn't expect such a note to land in my e-mail inbox. I learned then that there are problems that arise in some patients' illnesses that demand immediate attention, but they may not realize that their symptoms of, say, intermittent lightheadedness might be a BIG DEAL. Instead, they leave a "little message" in my in box that I discover (to my horror) amongst the sea of spam and administrative e-mails. Fortunately for this gentleman, there was not an undue delay, but I realized after this interaction that all it might take is one missed e-mail in my line of work and the result could be catastrophic.

That's why we have an answering service 24/7/365. That's my we have call schedules to assure a doctor is available, always.

And on a personal side, I try to have a family life outside my "day job." E-mail, like pagers, is an incredible technology that can reach us whereever we go (how many of us have been paged in the bathroom?), but it has its downside. While many of us want to be omnipresent for our patients, there also comes a time where we need a break (Vacation? What's that?). If I logged on each morning to check my e-mail and attended to the latest round of problems on vacation, I wouldn't be on vacation, would I?

E-mail doesn't give anyone a break. Messages just sit in your "inbox" ready to pounce on you when you return.

I laugh at executives in the business world who feel e-mail is efficient as they wade through their 200-500 e-mails a day. Yes, Virginia, information overload exists in the electronic era. And don't get me started about spam...

E-mail is not bad for many routine things in health care, like refill requests and the like. But it takes time each day to empty my "inbox" of all that spam, "informational administrative" e-mail blasts, and well-meaning CME postings from the 300 other divisions in the hospital that I really have no interest in. The time it takes to delete all those e-mails I'd rather be devoting to patient care.

So for now, I'll stick with the old fashioned land-line and personal interaction. Anyone else have thoughts here?



Anonymous said...

Dr. Wes, there are some things that my PCP would never ever have "heard" if all of our communication had been in his office. Emails made it possible for me to "say" things which would otherwise never have been said.

However, I never expected him to deal with emails outside of his office - or office hours ...

I think that emails have a place in the physician/patient relationship, but it should supplement - rather than substitute for - something that's already working properly.

Excellent post ... thank you!

Anonymous said...

Dr. Wes, I believe that emails can be used for some communication between patient and physician, but perhaps the physician needs to limit that type of access to certain patients. I have communicated via email with my cardiologist on a few occasions, but I certainly would not abuse this privilege that he has given me. I have too much respect for him to take advantage of his time, nor would I want him to think I'm a pest. I believe I have a better relationship with my physician based on some of our email communications.

Thanks for this post. I hope others comment too.