I am fortunate to work at an institution that has a fully deployed electronic medical record (EMR) system that incorporates outpatient physician notes and inpatient notes under one umbrella. By and large, patient care is facilitated since both outpatient and inpatient notes appear simultaneously in the patient's chart, along side telephone messages and clinical results. While there are plenty of kinks to work out, most of us have to admit that there are huge patient care advantages to such a system.
The system also promotes a secure e-mail service for patients to e-mail their physician and a mechanism to have their results forwarded directly to them. With the ability to empower patients directly, many would consider this as the Utopian model for heath care delivery of the future.
And what could be better? Patients get virtually unlimited access to their health care provider, 24-7. Results are whisked to the patient. Speed. Efficiency. "Green." It's all good, right?
At least until a complicated health care situation occurs.
Then the four-page e-mail is sent, asking for clarification. A lengthy reply is made attempting to answer every question. The response is quickly followed by questions. More answers. "What do you mean?" "But what I thought you said..." More responses. More questions. "But have you considered ...?" "But I have to be in New York that weekend. Do I really need it?" "I've been thinking..." "What about....?" "Like I said..." Back and forth. A constant stream of electronic anxiety.
Then a pause.
"Doctor, why haven't you answered my question, doctor? I sent you three mesages today and haven't heard from you. Doctor? Your nurse practitioner wrote that you'd ... I don't understand why there's such a disconnect...."
Hours and hours of back and forth, pounding on a keyboard producing the cold, hard blandness of text. Broken streams of communication. No emotion. No visual cues. No empathy. No give and take.
* Click clack, clack click. *
It's about as inefficient as it can get, absorbing huge amounts of physician and nursing time.
Granted, it doesn't happen often. Most patients are sensitive to this mode of communication and e-mail's inherent limitations. But occassionally there are the highly computer-saavy patients who live online, over-use the service, and expect their answers instantaneously. The reality is that few doctors type well, are still putting their hands on and in patients, and do not continuously reside at a computer screen (despite what the hospital administration wants you to believe). That being said, there are still many times where it is far more efficient to see the doctor in person when tough treatment decisions have to be made.
That is, of course, as long as the doctor can pull his face from the computer screen during the office visit.