Kevin, M.D. - Medical Weblog

As a patient who did use e-mail with specialist for a while, I would say that it has one significant advantage: it provides a written record of the physician's advice which is much easier for the patient to follow that a few rushed comments in a rushed consult. Used properly (and an agreement between doctor and patient beforehand could easily set the criteria) it could be a very valuable tool. However, I also experienced the doctor copying an e-mail I'd sent to him to a nurse I'd never met, which I didn't like much...I mean, would a doctor invite a nurse to listen outside of his office door during a consult without the patient's knowledge?

Bottom line, e-mail just has to be used intelligently by both parties and both have to understand the wishes and expectations of the other. Seems to me that most problems in doctor-patient relationships are very avoidable with improved communication.
 

Not to sound rude, but what exactly was your problem with the message going to the nurse? I mean, I assume it wasn't sent just for her personal amusement- he must have sent it for the purpose of coordinating care. When you're admitted to a hospital countless nurses and staff you've never met witness your medical record without you knowing. When you get treatment from a doctor in a private office, you've got to expect that his or her staff will have access to your health record as well (whether in the course of filing, for billing purposes, etc.)
 

That's not rude...it's a fair question, and I agree to a point that I should have anticipated my e-mails weren't private. This is a somewhat special situation, in that I had undergone seven surgeries within two years from this physician for a recurring lesion (in total, 23 office appointments during that period). By the time the e-mail exchange in question occurred, we were on a somewhat more familiar level than perhaps the typical doctor/patient. I'd have written the e-mail in question more formally had I understood it was not going to be private.

Nevertheless, I appreciate your point. I would have preferred, rather than just forward it to someone I didn't know, the doctor had told me first: "I need to delegate this to nurse X; may I forward your e-mail to her?" Or, he could have given her the direction in his own words without including text of my original e-mail. There were other ways to handle the situation that would have worked equally well and not left me feeling like I had no control or input in the situation.

Obviously there are two sides to it and both have merit. Appreciate your interest.
 

As a another patient I think that some trivial matters - like the ones where the nurse's response is OK, when you are conveying some message, etc. e-mail would save everybody's time and doesn't carry much risks. It also can provide a record as the poster above said - e.g. when a patient notifies the doctor that he/she decided not to do something doctor recommended.

A couple of examples:
After changing to a different type of medication, my doctor asked me to call in about a month and tell how I was doing. The doctor is a member of a busy medical group and when you call, you get put on hold, sometimes for a fairly long time. There is no option to just leave a message and the phone only answers during work hours. So, in order to call just to convey a simple message the doctor asked for (for whatever reason), I need to call from work and use up at least half an hour of work time. All for a message that could be safely sent via e-mail or just left on an answering machine. Maybe the doctor's request was just a way to convey to me that she cares and she didn't care about the answer or maybe there was some reason - I am not a doctor so I cannot say. At any rate, in similar circumstances, the ability to send e-mail "Dr X asked me to call and say this, everything is fine" would not only have saved my time but also would kept phone lines slightly more open for people with real need.

Another similar situation if a couple of weeks after an office visit, the patient decided that he or she has some side effects to a prescribed medication, calls the office, talks to the nurse, nurse e-mails the doctor, gets reply, then calls back to tell that the doctor dialed another prescription. This exchange could easily be handled via e-mail either directly to the doctor or to the nurse. In the latter case the nurse could've just forwarded the request rather than have to write it down. The e-mail would've save everyone's time and reduced the number of phone calls.

Another case if after the visit and after looking at the results of the test the doctor decides to prescribe some medication and has the nurse call the patient. If the patient refuses, the e-mail would provide a record.
 

I agree. I used e-mail for two purposes: (1) to confirm that I understood what the doctor said in consults correctly, and (2) to report back to the doctor between 6-month return visits regarding status, in hopes that it would help him with diagnosis and treatment. Like the previous poster, I didn't feel either of these required bothering anyone by phone, but I felt they were valid communications. I wonder what clinic Risk Management attorneys think of such e-mail?