Physicians E-mailing Patients - Episode 17
Erika S. Fishman, Director of Research

With the comprehensive nature of health information on the Internet today, we are still pondering how the Internet has changed the roles of the physician and patient. Namely -- is the new “good” patient the patient who has searched the Internet?  Is the new “prudent” physician the physician who merely guides the patient to the correct information?  Regardless of how we now define the physician-patient relationship, the balance of power has no doubt shifted.

One of the ways in which we see a change in the relationship is through communication.  Communication has largely been heralded as the key to all successful relationships, but with the rise of managed care adding to the administrative roles of physicians, synchronous communication (i.e., real time) often becomes impossible.

The emergence of email promises to make physician communication easier, by allowing parties to connect through an asynchronous channel better suited to accommodate hectic schedules and constant mobility.  Online connection also holds the potential for personal and professional benefits, lower administrative costs, and ultimately, improved health outcomes. Aside from efficiency, such advantages include the potential for better health outcomes through increased treatment adherence and condition updates, as well as serving to keep the “worried-well” out of the office.

Online communication between physicians and patients has been increasing since 2004, with nearly 30 million consumers reporting to connect online with a physician today.  However, future growth in patient-physician connectivity will depend on more than just consumer interest –- the supply of these services will have to increase to meet the demand, essentially putting the burden on the physician.

Today, 36% of all physicians report to communicate online with patients; the majority of such physicians perform clinical activities with patients online.  But even among physicians who are defined as currently “connected” there is reluctance and skepticism – with liability at the top of physicians’ minds.

It is vital that the quality of the online information transferred is preserved and parties do not overstep boundaries of their new online roles. As we look ahead to the future of email connectivity, we need to prepare for the new roles and responsibilities involved parties must accept, ultimately prompting us to form guidelines for this form of communication and forcing us to examine liability in a new context. Ethical guidelines for use of email in the clinical setting are being formed to help physicians along in their transition to online venues, providing direction for situations when email should not be used, as well as appropriate length, tone, and shorthand within email messages. 


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It is these issues that companies such as RelayHealth conquer, by offering secure online patient-physician communication through encrypted sites.  To easily connect the two parties, physicians can offer up the patient the URL for the RelayHealth site, or the physician can send the patient an online invitation to use the site.  Look for such secure messaging services to grow, as over one-quarter of physicians who do not use such programs report to have future interest in this realm.

Although email promises to improve health outcomes, since many cannot access online channels we may actually begin to see wider health disparities between social classes. And of course, monetary reimbursement for email use is still a matter of concern, as pilot projects begin to test how to approach this issue.

Online channels for physician communication may never be able to fully substitute for telephone and face-to-face sessions -- at least until the literacy rate in the U.S. becomes 100%. But online connection will continue to proliferate, bringing us full circle with the return of house-calls –- only now in the form of web-calls.

The physician still maintains leverage in the physician-patient relationship because she holds the power to direct where we go from here.  Unfortunately, benefits of technology are often the least transparent to the physicians who often shell out time and money for the applications. If physicians do not adopt interactive applications, consumers cannot follow.


If you have questions, comments, or suggestions for future podcasts, please email podcast@manhattanresearch.com.


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