Now patients want to email you. Will it ever end?

You may feel that patients already have more than enough ways of reaching you � but they want more

By Jack Ellison

A New Brunswick family physician's been using email to communicate with patients for almost two years. Other than to say he finds it efficient, he doesn't much like to talk about it.

A Regina psychiatrist has been experimenting with online consults with patients since the beginning of the year, and finds the results 'spotty.' She notes, "you have to pick and choose the patients carefully, particularly in my specialty. I've found it useful as a back up. In a couple of cases, I think it's helped to head off more serious problems. I find I usually ask them to come in and I make it a rule not to suggest anything without seeing them. The one thing I can say about email is that the patients love it but I've been cautious and I think you have to be. I've only given out my email address to a handful of patients so far."

A rural Newfoundland GP is enthusiastic about the prospects. "My patients are spread out all over the map," he says, "reaching them on the computer could be a real help especially in winter when it's hard to get around. Only problem is, see, I have a computer and email and all that but hardly any of my patients do."

A Scarborough, Ontario cardiologist is less enthusiastic. "I've had patients ask for my email address and I've refused point blank. In my view, long distance medicine is bad medicine. I can't see myself ever using it."

Wherever you sit on the matter of electronic communication with patients, it's already here and will certainly become more common. An important reason why physicians have to deal with the new phenomenon, as noted by the Regina psychiatrist � patients like it.

As provincial governments look for new and more efficient ways to provide healthcare, email is certain to be considered. One of the first questions the bureaucrats will ask is, does it save money? The jury's still out on that one. Though there are few Canadian stats on the subject, US doctors are slowly beginning to use email and there's been some research into its validity. A California study, for example, estimated that capitated physicians � Health Maintenance Organization participants with set patient rosters � could save one dollar per patient per month by using email when compared to a control group. How so? Office visit expenses were eliminated and the patients paid directly for the service. On the other hand, a University of Michigan Health System study found that email didn't save either time or money.

The US experience does bring up one essential issue. Who pays? At present no province offers compensation for email communications and those MDs that do it apparently offer the service gratis � even though they may have to go to some trouble to offer it.

Many patients say they're willing to pay a nominal fee but at present that's not an option here. Even in the US where some patients do pay, and there's some suggestion that even some third-party payers may step up, it's unlikely to be a money making proposition. Estimates are that fees to MDs would range between 10 and 15 dollars and that billing costs would all but wipe out any gains.

GET ENCRYPTED
All parties agree that doctor-patient electronic communication on personal medical issues should be encrypted (in the US it's the law) to ensure that it remains private. That means the use of passwords and messages that are coded to keep them from prying eyes.

There's a lot of encryption software and services out there, some of them free, but like any new software it requires some attention to get up and running. If you're interested, visit http://www.wowarea.com/english/help/crysoft.htm for a long list of resources. For more, go to the google search engine and type in "Canadian encryption software."

Physicians using email communication need to be judicious. The dos and don'ts include: