Opinion articles

Tuesday, January 4, 2011

Why I Stopped Email Communications

Entering the computer age and its ease of communication, I jumped into the digital forest some 12 years ago. I decided that the ease of communication and restoring comfort to patients without the need for a phone call would save us both time and energy.


The first few emails from patients were specific regarding their care and arrived during the waking hours where I had the ability to respond relatively quickly. But then a trend of late evening emails started.


The following examples of emails back and forth will set the stage of what happened later:


(9 PM)

Patient A: I developed a headache. What do I do?


There is a uniform dilemma that resides in such a broad question. So I asked the following questions:


Me: Which part of the head aches? Is the pain sharp, dull, evenly distributed? Is it associated with dizziness? Are there any other symptoms associated with it? Is this the first time or has it happened before? Do you have any double vision?


Patient A: No it is all over and seems to be getting worse.


Me: Did you take any medication for it?


Patient A: None


Me: Are you allergic to Tylenol or Aspirin?


Patient A: No, can I take some?


Me: I would prefer Tylenol. I do not have access to your medical records this late at night but if the symptoms do not go away, I would recommend going to the Emergency Room.


Patient A: You think this is that serious?


Me: I don’t really know without an examination.


Patient A: My husband says that I did not drink my coffee today and that might be the reason.


Me: Your husband might be right, but there is no way for me to know.


Patient A: I’ll drink some coffee and take a Tylenol then.


Me: Try the Tylenol before the coffee if you want to go to sleep tonight.


By now having sat and circled around in front of the computer for three hours, it was midnight. I had not heard from her in 20 minutes. I left the computer on and went to bed. The “You’ve got mail” woke me up. I gathered my bleary eyes to focus on the monitor, clicked the return button, and there was the email response:


Patient A: It was the coffee!


Things in email-land did get a bit easier as I posted signs in the office that email was for routine questions only and that an immediate response may not be available depending on the time of day and that if anyone had an emergent situation, a phone call would be more appropriate.


People followed the rules reasonably well for the first few weeks or so after the signs were posted and then these emails came through:


(At 11 PM)

Patient B: Is the flu going around?


(At 10 PM)

Patient C: What do you think about Chiropractors?


(At 9:30 PM)

Patient D: Can I use Acupuncture for de-stressing?


(At 10:30)

Patient E: Does Broccoli prevent cancer?


That was it -- two years and three months later, a good idea had to be scrubbed. I changed the email address and posted signs that I would not be able to communicate with patients via emails anymore.


Some patients were upset, others complained, but most did not care.


The art of communication is lost when a few words are followed by a question mark, as surely is the answer that follows in similar cryptic format to conserve time. Something gets lost in the translation.

Limited word responses are cold, impersonal mostly and do not foster connectivity.


True, the consumer wants 24/7 access to information and what better than coming from their own physician, but answers given in the context of a face-to-face setting or at least verbally where linguistic inflections can be easily deciphered by either party to understand the question and the answer makes for a meaningful communication.


Of course the consumer will be desirous of “nick of time,” instantaneous response to cajole a “Good Doctor” recommendation and post on whatever website, but given the Damocles Sword of litigation and parsing of every word by the legal profession, the email communication may be fraught with unintended consequences.


Social Media interaction with direct, personal responses also share the same sinews of dark power. A broad non-personal recommendation becomes meaningless to whom it is offered, and yet it would appear to be the safest means of written communication. This, especially since the entire picture of the complaint cannot be contained in a few words.


The debate will rage and maybe a technology will arrive that will be reminiscent of a holographic doctor offering advice at the press of a button and all will be happy.


But then again…”Press five to review your question.” “Press six to receive an email.” “Press seven to speak with a hologram.”


PARVEZ DARA, MD, FACP (@JediPD), a hematologist/oncologist in Toms River, NJ, also has a blog, “The Arts, Sciences and Medicine: The Physician and the art of science and science of medicine,” at jedismedicine.blogspot.com