A Strong Prognosis for E-Mail in Medical Care

While fishing in rough waters off the coast of Mexico, David Cargile slipped and slammed his ribs hard against the boat railing. Miles away from his doctor, the 52-year-old Laguna Hills businessman was in great pain and needed some quick medical advice. So he taped up his aching ribs, headed ashore and sent an e-mail to his doctor.

His physician, Dr. Joseph Scherger, e-mailed back asking the severity, duration and location of the pain. He concluded the injury was not serious.

“I handled a problem that might have required a couple of visits and an X-ray,” Scherger said, recalling the incident earlier this year. “I never actually saw the patient. In the future, I think every doctor’s office will be a hub for information that is available electronically.”

At UCI Medical Center, where Scherger practices, and at an increasing number of doctors’ offices across the state, patients like Cargile are sidestepping secretaries and voicemail, e-mailing their concerns directly to their physicians.

Some legal experts say that, without guidelines, doctors might be risking malpractice lawsuits when they offer diagnoses online. And some patient advocates raise concerns that such high-tech communication excludes people who cannot afford it.

But doctors and patients who use e-mail say they like the quick, personal touch it adds to their relationship. It is useful, proponents say, for reporting cholesterol counts and prescribing diet and exercise plans, informing patients about the results of physical examinations and fielding prescription renewal requests.

“It is the kind of personal attention you don’t often get with doctors,” said Raymond Bruer, another patient of Scherger’s. He prefers waiting for e-mail rather than sitting in a doctor’s office, he said. “It’s like getting a letter.”

For complicated or highly confidential matters, such as HIV test results, doctors say they prefer to pick up the phone or see the patient in person.

E-mail “only works for very simple issues, for providing answers to questions for which there is no emotional impact,” said Dr. Thomas Cesario, dean of the UCI College of Medicine.

Increased use of e-mail in medical treatment may be an outgrowth of managed care, said Sam Roth, assistant executive director of public affairs for the Orange County Medical Assn.

“This may be a partial response to the pressure that has built over the years by plans that add patients and take away time that doctors can spend with their patients,” he said.

Whereas a doctor and patient might play phone tag all day trying to reach each other, e-mail can be sent whenever either person has a free moment.

Eugene Volokh, an Internet expert and professor of law at UCLA, said, “It may sound like a big deal to switch to e-mail, but it is really about how well you use the technology--not which technology you use.”

“Telephone and e-mail can both be quite informative and interactive,” he said. And “both are usually quite secure” in terms of privacy, though neither is foolproof.

Michael Cohen, professor of law at Chapman University in Orange, pointed out that e-mail is a bit more risky for doctors.

“If they put it in writing, then there is a record,” Cohen said. “From a physician’s point of view, it is reducing something to writing and increases risk.” A patient who has a doctor’s advice in writing might blame a future health problem on an e-mail misdiagnosis, Cohen said.

Still, he said, “It potentially could reform the patient-doctor relationship.”

That change is not happening quickly.

“Physicians in California are not really into the Internet or e-mail as operational tools,” said Dr. David Hsu, who is building an electronic system to connect the state’s gastroenterologists.

Meanwhile, advocates for patients say they are concerned that online doctor-patient communication in the long term might exclude less affluent people.

“We have some real concerns for the poor people. They get left out,” said Felix Schwarz, chief executive officer of the Healthcare Council of Orange County, a patient advocacy group based in Santa Ana.

If medical dialogue moves increasingly online, people who already get little attention from the health care system will fall even further behind, he said. “They don’t have access now, when other people have electronic access.”

But for patients like Cargile who use modern technology regularly, use of e-mail for medical matters is a positive development.

“From a practical standpoint, it allows doctors more time to see people who they actually need to see in person,” Cargile said.

He conceded that “we are in a litigious society” and that some physicians might have legal concerns. “But for this to work, the doctor-patient relationship should be based on trust,” he said.