In this age of social media, even basic e-mail exchanges are already verging on obsolescence for people under age 30. More young people now use Twitter than e-mail. But whether messages are conveyed by e-mail or Twitter or Facebook, the advantage in patient-doctor exchanges is that they all originate at times convenient to the sender and recipient; appropriate phrasing can be thoughtfully chosen; concerns can be reflected on; and decisions can be considered before being uttered. Standard answers and qualifications to commonly asked questions can be composed in advance, which saves time and trouble for physicians.
Yet, in 2004, fewer than 10% of the US public was communicating with their doctors electronically. In the United States and Europe, only 20% to 25% of doctors were using e-mail and, then, only to communicate with select patients.2 A survey conducted by Manhattan Research found that the figure had gone up to 31% by the first quarter of 2007.3
Quicker, more efficient communication
In a study of 4203 primary care physicians conducted in 2005, only 16.6% had personally used e-mail to communicate with patients, although 63% did use e-mail for other purposes.4 An increasingly sophisticated, knowledgeable, and wired public demands individualized care from physicians and wants the convenience of being able to e-mail for appointments, send prescription requests, receive test results, and get answers to post-visit questions that they had forgotten to ask.5 Young people, especially those under 35, are overwhelmingly confused by a basic question: “Why can’t I get advice from my doctor over mobile, Web-enabled technology using text messages just as I do from other service providers?”
In 2009, despite the widely upheld ideal of a medical system that is “patient-centered” and responsive to patient needs and preferences, very few patients are communicating electronically with their health care providers via basic e-mail, and far fewer via social networking tools such as Twitter (whose more regular use could enable a quick 140-character update to advise chronically ill patients, for example, that their blood test results were normal).6
CHECKPOINTS
■ E-mail provides a medium through which patients can express worries and concerns and physicians can respond in a patient-centered way.
■ E-mail and social media exchanges with patients do, however, carry potential liability in a variety of areas, including confidentiality, privacy, security, timeliness of response, and clarity of meaning.
■ Basic e-mail exchanges are already verging on obsolescence for people under 30 in this age of social media.
Patients now expect electronic communication in all modern, professional service interactions. In a study that explored the extent to which e-mail messages between patients and physicians mimic traditional medical dialogue, 8 volunteers supplied copies of their past 5 e-mail exchanges with their physicians. The investigators concluded that e-mail provides a medium through which patients can express worries and concerns and physicians can respond in a patient-centered way.7
Even the decades-old term “patient-centered” seems anachronistic when discussing these concepts. A growing proportion of patients around the world are so-called e-patients, ie, Web-savvy, often chronically ill patients who turn to e-mail correspondence and online illness communities to participate actively in their own care. Modern participatory medicine demands that social media and e-mail be harnessed in the clinical setting and beyond.
For psychiatrists, there are specific challenges. Psychiatrists tend to be “late adopters” of new technology and, like other doctors, do not want to be communicating with patients outside office hours when the service is nonreimbursable.8 In addition, psychiatrists are sensitive about potential boundary crossings—electronic communication seems more informal, less business-like than making a telephone call. E-mail may also blur the distinction between professional interest and friendship.9 Realistically, however, between-session issues need to be addressed—appointments need to be made or cancelled, emergencies occur, and prescriptions need to be filled; questions need to be resolved, quick advice may be required, and misunderstandings need to be cleared up.
Ten years ago, in the still relatively early days of e-mail, 2 of us wrote about the promise and perils of e-mail communication with patients. We ended by warning that “psychiatrists of the future may be just as legally liable for not using technology as they may be now for applying it in novel and nontraditional ways.”10 Has that time come? Since malpractice is defined by comparisons with local professional standards, is it now malpractice to ignore e-mail or social media communication from patients?
