I’ve never lived in a world without e-mail. No, I’m not one of those millennial kids; e-mail has been around for a long time. Sending messages between computers dates to the 1960s, but most people consider 1971 to be the birth of e-mail. That’s when Ray Tomlinson added the @ symbol to separate users’ names from their e-mail addresses.
Today, e-mail is ubiquitous. You can e-mail your mother, your colleagues, or your cable company. You can even e-mail the president of the United States. Other than the pope and most physicians, there aren’t many people you cannot e-mail. (Although, interestingly, you can reach His Holiness on Twitter @Pontifex.)
We physicians have historically had a few good reasons to avoid e-mailing patients, but many of those objections are unwarranted. As part the meaningful use EHR incentive program from the Centers for Medicare & Medicaid Services, secure messaging will now be required to be eligible for rewards. Although many physicians cite security as a concern, most electronic medical record systems now have patient portals that allow for secure, safe messaging. Encroachment into private time, however, is still a concern for many physicians.
At Kaiser Permanente (KP), we’ve been using secure e-mails with our patients for more than 5 years. When we started, I had some of the same concerns as most doctors: When am I going to have time to do this? What types of questions will patients send? As it turns out, the system has been wildly popular for patients. In 2013 alone, we replied to more than 14 million patient messages. We encourage our patients to use e-mail to stay connected with us, because it leads to improved patient experiences and improved outcomes.
Managing e-mail in-boxes is difficult work, and we KP physicians constantly try to find ways to be more efficient. E-mail does sometimes encroach on my personal time, but I’ve discovered that’s okay. As it turns out, e-mail encroaches on my entrepreneurial brother’s personal time, my financial planner’s personal time, and my plumber’s personal time. Being always connected is a modern luxury and a curse. It’s also part of being a professional.
Here are some steps I’ve taken to manage my patient e-mails. First, I always remember that this electronic message is connected to a real person with real worry. Second, I remember how appreciative patients are to get a message from their doctor. E-mail a patient after 8 p.m., and they will never forget you. Third, clearly delineate time to take care of business. It never feels burdensome in part because I am in control. I choose to e-mail patients not because I have to but because I’m that doctor and it makes me feel good.
This weekend, for example, I did patient messages in a Jackson Hole, Wyo., coffee shop while on vacation. Just as I opened my computer, I noticed a young guy in a fleece jacket next to me checking his e-mail while his wife and two kids enjoyed muffins and hot cocoa. While I was waiting for my wife, Susan, to order our lattes, I overheard him make a call to his office: “Yes, I’m out, but why don’t you e-mail me that and I’ll get right back to you.”
I’m right with you, buddy, I think. I use my token and the wifi there in Wyoming to access my patient e-mails. There are only five. The messages are like most I receive: “I have a new spot,” or “The cream you gave me isn’t working,” or “My acne is better, so should I reduce the spironolactone?” I hammer replies out in 10 minutes.
My wife returns with lattes and opens the local paper while I review 14 biopsy results from 2 days ago. For most of them, I use a template and the secure e-mail to send patients their results. I then send a few notes to some patients, advising them to follow up with me for excisional surgeries.
The work I was doing was not additive; the questions my patients sent would have had to be addressed at some time. In fact, if they had called, then they would have left a message with a nurse who would have sent a message to me, which I would have had to reply to, and then send the message back to the nurse who would have to reply to the patient.
Despite our love/hate relationship with it, e-mail has been one of the great innovations of the 20th century, and it is the primary form of communication in the business world. According to one study, more than 100 billion business e-mails were sent and received every day in 2013. Yet, fewer than one-third of physicians use e-mail to communicate with their patients.Personally, I have found patients to be generally understanding, courteous, and appreciative of e-mail. Of course, there are a few who don’t follow good etiquette. (One of my primary care colleagues relates a story of a patient who e-mailed her every time she had a bowel movement. Gastroenteritis can significantly add to e-mail burden, apparently.)