E-mail is arguably the most common form of communication in the Information Age, but don't count on getting one from your doctor.
Despite growing use of computer technology in almost every other facet of their profession, American doctors are reluctant to use e-mail when interacting with patients, a study to be released Thursday shows.
Barely one-quarter of physicians use e-mail or other electronic communication to reach patients, up from 20 percent four years ago, according to the Center for Studying Health System Change, a Washington-based research institution.
By comparison, more than half of doctors now use computers to store and access patient notes, up from 37 percent four years ago.
"Most businesses have e-mail (access) because that's what their customers want," said David Cutler, a health economist at Harvard University. "Customers want convenience, but nobody in health care gets paid for it."
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In their offices, doctors are under constant pressure to curtail time spent with patients, said Marcy Zwelling-Aamot, an internist with a private practice and former president of the Los Angeles County Medical Association. The last thing most of them want is to give patients another way to get a hold of them.
"They don't want to be bombarded," said Zwelling-Aamot, who runs a concierge practice, meaning she doesn't take insurance. Her patients pay her $1,500 a year for full access to her services, including e-mail consultation.
But "I have 500 patients," she said. Other doctors may "have 3,000 patients."
Wider use of electronic communication could save time and money and improve health-care quality, those who use it say.
Howard Krauss, a neuro-ophthalmologist with a practice in Los Angeles, put his e-mail address on his business cards. "In general, probably less than 10 percent (of patients) use the e-mail address," he said, "but close to 100 percent of them feel comfortable knowing I am available."
Krauss, who carries a BlackBerry mobile communications device everywhere he goes, doesn't get reimbursed for e-mail consultations, but he has found it makes his practice more efficient. Non-urgent cases can be handled swiftly without tying up office time, and e-mail exchanges serve as a record of the consultation that can go directly into a patient's file without the need to transcribe, he said.
Patient Gary Bart, 60, of Beverly Hills, Calif., said Krauss' e-mails came in handy when Bart was diagnosed with a rare case of melanoma in his eye socket earlier this year.
Bart, a retired movie producer, developed complications from the surgery to remove his tumor, but Krauss, who had been coordinating the care, was at a conference in Chile. Krauss used e-mail to direct Bart's care by another doctor in his office and kept in touch with his patient to reassure him.
"He was halfway across the world but on top of the situation," Bart said.
Health plans say they are not averse to paying doctors for electronic consultations, but they would like a more structured setting, such as a secured Web site that screens patients for symptoms and differentiates actual clinical consulting from administrative questions, such as checking whether lab results are in.
"In general, it takes more organization and time than doctors are willing to take," said Jeff Kamil, medical director for Blue Cross of California.
Blue Cross reimburses doctors who see patients through an Internet-based service, RelayHealth.com, a kind of a virtual meeting place for doctors, health plans and patients.
Doctors pay a fee to join the service and health plans — currently fourteen across the country — agree to reimburse services rendered through the Web site. It keeps patients' health records and provides prescription services. Patients who belong to one of the fourteen plans can join and find a doctor in their network. RelayHealth says it has about 7,000 participating doctors and nearly 1 million patients. RelayHealth is one of the largest services of its kind.
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