In virtual pain? E-mail your e-doc

May 4, 2002

Wouldn't it be nice if getting a prescription renewed was as simple as firing off an e-mail? What if, instead of listening to Michael Bolton Muzak for 20 minutes while on hold with a harried nurse, you could type in a referral request and click "send?"

That's a feasible option, according to a study from researchers at the University of Michigan Health System being presented at today's annual meeting of the Society for General Internal Medicine in Atlanta.

Using a system that prioritized patient-to-doctor messages, researchers found that e-mail increased the frequency and quality of communication between patients and doctors without overwhelming in-boxes or sandbagging already-hectic workloads. It also improved patients' attitudes about communicating with their doctors.

Most doctors have been hesitant to delve into e-mailing with patients.

"Providers are concerned about workload," said Dr. Steven Katz, a U-M associate professor of medicine and health management and policy, who led the study. "Are we going to get peppered with messages?"

In addition to fears of a wading through a daily tornado of spam, health care providers are worried about the effectiveness of e-mail communication, privacy and billing. Even in the study, some doctors encouraged patients to telephone about sensitive information.

In the study, half of the patients were asked to communicate with doctors in usual ways, which included some e-mailing with doctors who already communicate electronically. Others sent e-mail to a single address that was sorted and "triaged" by staff and nurses. The staff forwarded messages to physicians when appropriate. Those asking for appointments, cancellations and other routine requests were handled by staff.

Researchers noted that the majority of patients kept their communications streamlined, asking one question or conveying one piece of information as they were asked to do. Only one sent an update with questions about five separate conditions. And only one forwarded her physician a message about "What to do if you lose your wallet."

"They didn't flood the system," Katz said. "Providers need to understand that patients are cautious about the use of this."

E-mailing his doctor has changed a lot for Gary Lester, 67. Lester, who is diabetic, lives in Jackson, but his primary care physician works at U-M's Briarwood Health Associates on Ann Arbor's south side. Instead of driving the 100 miles round-trip or playing phone tag, he keeps Dr. Steve Gradwohl apprised of his blood sugar levels via weekly e-mails.

"I'm an old guy, so I'm not into modern technology," Lester said. "But I think it's a tremendous, tremendous asset. Getting him on the phone is almost impossible."

Gradwohl said his practice has been getting patient e-mails for three to four years, and it works. "It allows patients to access us at their convenience, which can be very difficult at some times," he said. "They can ask questions at their pace a little bit more."

He also said he spends just 15 to 20 minutes a day answering most of his e-mail. Many are just looking for resources, updating him on an illness or giving him a status report after starting or changing a medication. If there's any question, Gradwohl has the patient make an appointment.

Katz said he thinks it will be a while before e-mailing doctors becomes a common practice nationwide. And there are questions that remain, including how to document e-mail conversations and whether to charge for e-mailed advice. (Gradwohl's practice does not charge, and has no plans to, he said.)

"There's an enormous need to help provider and patients navigate increasingly complicated systems," Katz said. "We're trying to evaluate how to get it there."

Tracy Davis can be reached at tdavis@annarbornews.com