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 the growing use of computer technology in almost every other facet of their profession, American doctors are reluctant to use e-mail when interacting with their patients, a recently released study shows.
Barely a quarter of physicians use e-mail or other electronic communication to reach patients, up from 20% four years ago, according to the Center for Studying Health System Change, a Washington-based research institution.
By comparison, more than half of doctors use computers to store and access patient notes, up from 37% four years ago.
The limited interaction between doctors and patients on the Internet is a symptom of a healthcare system that in many ways is disconnected from patients' needs, some experts said.
"Most businesses have e-mail because that's what their customers want," said David Cutler, a health economist at Harvard University. "Customers want convenience, but nobody in healthcare gets paid for it."
Some health plans have begun reimbursing doctors who interact with patients on specially created websites, but the numbers are still negligible and for the most part doctors are not paid unless they see patients face to face.
In their offices, however, doctors are under constant pressure to curtail the time spent with patients because they are paid by volume, said Dr. Marcy Zwelling-Aamot, an internist with a private practice in Los Alamitos and a former president of the Los Angeles County Medical Assn. The last thing most of them want is to give patients another way to get ahold 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 consultations. 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 quality of care, those who use it say.
Howard Krauss, a neuro-ophthalmologist with a practice in West Los Angeles, puts his e-mail address on his business card. "In general, probably less than 10% [of patients] use the e-mail address," he said, "but close to 100% of them feel comfortable knowing I am available."
Krauss, who carries a BlackBerry everywhere he goes, isn't reimbursed for e-mail consultations but has found that they make his practice more efficient. Nonurgent cases can be handled swiftly without tying up office time, and e-mail exchanges serve as a record of the consultation and go directly into a patient's file, he said.
Patient Gary Bart, 60, of Beverly Hills said Krauss' e-mails came in handy when Bart was diagnosed with a rare case of melanoma in his eye socket this year.
The retired movie producer developed complications from the surgery to remove his tumor, but Krauss, who had been coordinating his care, was at a conference in Chile at the time. Krauss used e-mail to direct Bart's care through 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 website that screens patients for symptoms and differentiates clinical consulting from administrative questions, such as whether lab tests are in.
"In general, it takes more organization and time than doctors are willing to take," said Dr. Jeff Kamil, medical director for Blue Cross of California.
Blue Cross reimburses doctors who see patients through an Internet-based service at 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 -- 14 across the country, five of them serving California -- agree to reimburse for services rendered through the website. It also keeps patients' health records and provides prescription services. Patients who belong to one of the plans can join and find a doctor in their network. RelayHealth says it has about 7,000 participating doctors and nearly 1 million patients. It's one of the largest services of its kind.
Kaiser Permanente, the state's largest health maintenance organization, with more than 6 million members, is rolling out a similar program. It is expected to be available to all members by the end of 2007. Kaiser officials said the system has decreased office visits by as much as 10% in areas where patients could communicate electronically with their doctors.
"Bottom line is, these things are very new," said Joy M. Grossman, a coauthor of the report, released Sept. 21 by the Center for Studying Health System Change. "As these tools evolve and get more sophisticated and payment methods evolve, we could see more physicians adopting" electronic communication with patients.