Find the right limits for e-mail consults between doctor, patient

Regarding "An e-visit primer" (Editorial, Nov. 13): Seventy-four percent of patients want e-mail consultation with their physicians. It was not reported, however, whether patients are willing to pay for e-consultations, nor whether they are willing to accept a lower level of care.

Despite the AMA's call for e-care to supplement, not supplant, face-to-face care, many stakeholders consider e-care a convenient and economical substitute for office visits. Some estimate that e-consults could save $7 billion by converting face-to-face visits to virtual visits.

Non-procedurally based specialties are perceived to be a perfect fit for electronic care. In the most extreme view, one might handle the majority of such visits by phone or e-mail and still approximate health care.

Yet physicians do more than just process digital data. The best health care is based on personal relationships and is dependent on nonverbal as well as verbal information. Truly informed and shared decision-making is built on mutual knowledge, trust and negotiation.

Patients may choose electronic care in a survey, and then be quite dissatisfied in reality. (No one explained my test results. All they did was order a thyroid test. I'm still tired. Now what do I do? It turned out I had heart failure and all I got was an e-mail about my blood work.)

Likewise, physicians may think it is a great idea to receive electronic information about patients' home blood pressures, blood sugars or symptoms of cough, without an appointment, but then wonder why it takes so long to finish the day's work, the revenue is so low and the joy is gone. A random flood of fragmented information, presented out of context, requires substantial physician time, ability and resources to manage appropriately. Remote management is neither cost free nor optimally informed.

There are clearly benefits to adopting electronic communication for some tasks, such as appointment reminders, healthy lifestyle promotions, patient education and even patient access to their medical records; the challenge will be to incorporate this technology in a fair and functional manner. Appropriate boundaries between electronic care and face-to-face care are needed to avoid shortcuts that in the long run could shortchange patients, physicians and even payers.

Christine A. Sinsky, MD, Dubuque, Iowa

Note: This item originally appeared at http://www.ama-assn.org/amednews/2006/12/25/edlt1225.htm.