Study: Parents want to communicate with pediatricians via e-mail

Doctors, however, have concerns about patient safety and privacy, as well as uncompensated care

May 20, 2010|By Laura Vozzella, The Baltimore Sun

As a native New Yorker living in Dundalk, Evelyn Lugo uses e-mail to keep in touch with friends and family in the Northeast. As an accounting student at Strayer University, she uses it to communicate with her professors.

So as a parent, why shouldn't she also turn to e-mail when she wants a word with her son's pediatrician?

"It'd be convenient if he's sick and I have to ask some questions," said Lugo, 23, the mother of a 19-month-old named Odany. "I think that's a good option."

Lugo has that option because she happens to take her son to a medical practice where at least one of the doctors allows parents to e-mail him. The overwhelming majority of parents would like to be able to do the same thing, according to a new study conducted by Johns Hopkins Children's Center.

They'd like to ask a quick question forgotten during an office visit. Or consult the doctor about a rash or fever. They want to ask, for peace of mind, with the ease of a mouse click, "Do I need to worry about this?"

But most pediatricians are not swapping e-mail with parents. While e-mail and text-messaging have crept into nearly every corner of daily life, they've made few inroads into doctor-patient communications.

Medicine has been generally slow to adapt to the electronic age, as reams of paper patient records can attest. But there are other reasons why doctor-patient e-mail has not become commonplace, said Dr. Michael Crocetti, a pediatrician at the Hopkins Children's Center and the lead researcher in the e-mail study.

Some doctors fear that parents will use e-mail in emergency situations. Or that it will lead to misunderstandings, on the part of doctor, parent or both, because tone and emphasis are so easily lost in e-mail. There are concerns about privacy, that a message sent to a nonsecure computer constitutes a violation. Some doctors fear that allowing patients to e-mail them would invite the presumption that they're on call 24-7. Others wonder whether they can be reimbursed for time spent sending e-mail. Or if moving toward that method of communication will lead to lower quality of care for poorer patients who don't have access to computers.

These questions loom so large that MedStar Health, which has six hospitals in Maryland and three in Washington, advises its doctors not to communicate with patients by e-mail.

But sooner or later, Crocetti and others agree, the e-mail revolution will come to medicine. And he believes patients and doctors will ultimately benefit.

"We have to embrace electronic communication in some way," Crocetti said. "We're going to need to figure out how to integrate it into the practice of medicine."

Some parents aren't waiting for doctors to figure it out. They're taking the initiative, asking doctors during office visits if they will accept e-mail, or shooting off messages without asking.

Mary Bonacci had an e-mail relationship with Crocetti even before he became her daughter's pediatrician. She manages the physician billing office for some Hopkins doctors, including Crocetti. So when questions about her daughter's health came up, it seemed natural to reach out to the pediatrician that way. And there have been plenty of questions over the years. Daughter Ava, nearly 6, was born with a fever and has been prone to very high ones — up to 107 degrees — ever since.

"If it's over 105 [degrees], I'm definitely in touch with him [by e-mail] every time," Bonacci said. "You send it off, and you immediately feel better."

In most cases, Crocetti e-mails back to ask if there are any other symptoms, such as stuffy nose, stomachache or rash. Usually there aren't, so he assures Bonacci that there is no need to go to the hospital.

"The e-mail has stopped us from going to the emergency room several times," she said. "You learn the pattern. You learn not to panic."

Bonacci has had less luck with her own doctor. She asked him a few years ago if he'd accept e-mail.

"He said he didn't do that," she said.

Not many doctors do, even though Crocetti's study suggests patients would be wildly in favor of it.

The study, co-investigated by Dr. Robert Dudas of the Johns Hopkins Bayview Medical Center and presented earlier this month at the annual meeting of the Pediatric Academic Societies in Vancouver, surveyed 229 parents of children seen at the Children's Center. Of that number, 171 described themselves as regular e-mail users. Of those, nearly 90 percent said they would like to use e-mail as a way to communicate with the pediatrician. Yet only 11 percent said they did so.

Dr. Scott Krugman, chairman of the department of pediatrics at Franklin Square Hospital Center, which is part of MedStar, is among those resisting that demand. The reasons range from patient safety and confidentiality to uncompensated care.

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