Tuesday, May 13, 2008

Go Ahead, Email Your Doctor...As Long As It's Not Serious

A near-death experience taught me the perils of online communication with my patients
by Dena Rifkin, MD

I read a news item today reporting that only one in three U.S. doctors communicate with patients via email. We doctors were accused of lagging behind other professionals in online communication.

Well, I am one of the physicians already communicating with patients via email. Like everything else about the digital world, it has its benefits and its drawbacks. I fully agree that simple things, like prescription refills, routine lab reports, and so forth can be handled best by email—often, these do not even require the intervention of a physician.

It's when we get into questions about health problems that email can be problematic.

I returned from a holiday weekend at home to find an email from a patient waiting for me. It had been sent late on Friday night. "Dear Doctor," my patient wrote. "I am very worried." He went on to describe bleeding, fatigue, and weakness. He asked me to call him when convenient. Then he ended the message: "I hope you have a good holiday."

Three days had passed. My heart was racing as I called his home phone number. Fortunately, he was still alive, but he had not sought any other medical help. I sent him directly to the emergency room and he spent several days in the hospital recovering from a serious intestinal bleeding episode.

All of our patients are asked to sign a consent form before we communicate via email, and part of that consent involves agreeing not to use email for acute health problems requiring urgent attention, like this one. But it is so easy to send an email—much easier than calling the on-call physician or going to an emergency room. I've had other, less extreme encounters where patients emailed about issues that really needed to be addressed in person.

If you choose to email your own doctor, realize that these e-encounters are probably best reserved for administrative problems or minor updates to ongoing discussions (like telling the physician that a recent medication worked well or didn't work), rather than new medical problems. At the very least, you'll save your doctor a Monday morning heart attack like the one I nearly had.

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