Patients ready for e-visits, but doctors are wary

Medical Matters

Medicine & Science

March 03, 2003|By Judy Foreman | Judy Foreman,SPECIAL TO THE SUN

Patients are clamoring for it. Many doctors hate the idea. But the smart money is on the patients to win this one, and it's a biggie: e-mail contact with doctors.

A Harris Interactive survey last spring showed that nearly 90 percent of wired folks want to communicate with their physicians online to ask questions, set up appointments, refill prescriptions and get test results.

Moreover, patients say they are willing to pay for e-visits. They figure that even paying for e-mail, they'll come out ahead: To see the doctor, a patient often misses half a day of work.

So, why won't doctors just get with the program? While some do, most resist e-mail because they're scared.

They're scared that e-mail will add work to their already rushed days. They are scared that patients will bombard them with dumb questions. They're scared that they might get sued for some e-mistake, a liability nightmare.

And they're scared of the "culture" shift that direct access will create (which is precisely what patients want). "Doctors are used to controlling interactions with patients," says Dr. Tom Ferguson, a senior research fellow at the Pew Internet and American Life Project. "With e-mail, they are not in charge."

But most important, doctors are afraid, with good reason, that they won't get paid for their time. Lawyers, accountants and other professionals turn on the billable-hours clock the minute the phone rings. But doctors do not get a penny for all the hours they spend on the phone with patients.

The solution is obvious: Pay doctors to e-mail their patients, either via insurance or direct pay by patients or some combination of both.

Granted, it may not be totally straightforward. For instance, if e-visits substantially replaced face-to-face visits, doctors could lose out, says Dr. Daniel Sands, clinical director of electronic patient records and communication at Beth Israel Deaconess Medical Center in Boston.

On the other hand, if e-mail with non-urgent cases allows doctors to have more visits with sicker patients whom they can bill at higher rates, doctors could benefit.

A key ingredient for safe patient-doctor electronic communication, Sands adds, is protecting confidentiality, something regular e-mail may not do. One way is via secure Web-based sites. The patient uses a password and ID to get onto the site and from there, e-mails the doctor. The doctor replies, via the Web-based site, and the patient then gets a regular e-mail telling him to check the site.

Already, some insurers are getting on board. In Massachusetts, Blue Cross Blue Shield and Tufts Health Plan are looking into it. In California, starting this quarter, the Blue Shield of California Foundation will pay its doctors for online consults, says the company president, Dr. Jeff Rideout.

This decision was prompted by a recent study sponsored by Blue Shield and ConnectiCare Inc. of Farmington, Conn. It involved 3,000 patients and 300 doctors. The insurers paid doctors $20 per e-visit, says Rideout. Patients loved it, he says.

Some dispute whether e-visits will really save money. Among the doubters is Dr. Steven Katz, associate professor of medicine and health management policy at the University of Michigan School of Medicine.

Katz and his team found in a study involving about 100 doctors and thousands of patients that while e-mail can improve communication, it doesn't cut phone calls or office visits. It doesn't reduce the number of missed appointments, either.

But an equally important finding, Katz says, is that patients "don't rain you with communications. ... They send courteous messages, health-relevant messages, non-urgent messages that are totally appropriate."

Judy Foreman is a lecturer on medicine at Harvard Medical School and an affiliated scholar at the Women's Studies Research Center at Brandeis University. Her columns are available on her Web site,

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