Study: Parents want to communicate with pediatricians via e-mail

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Study: Parents want to communicate with pediatricians via e-mail

As a native New Yorker living in Dundalk, Evelyn Lugo uses e-mail to keep in touch with friends and family in the Northeast. As an accounting student at Strayer University, she uses it to communicate with her professors.

So as a parent, why shouldn't she also turn to e-mail when she wants a word with her son's pediatrician?

"It'd be convenient if he's sick and I have to ask some questions," said Lugo, 23, the mother of a 19-month-old named Odany. "I think that's a good option."

Lugo has that option because she happens to take her son to a medical practice where at least one of the doctors allows parents to e-mail him. The overwhelming majority of parents would like to be able to do the same thing, according to a new study conducted by Johns Hopkins Children's Center.

They'd like to ask a quick question forgotten during an office visit. Or consult the doctor about a rash or fever. They want to ask, for peace of mind, with the ease of a mouse click, "Do I need to worry about this?"

But most pediatricians are not swapping e-mail with parents. While e-mail and text-messaging have crept into nearly every corner of daily life, they've made few inroads into doctor-patient communications.

Medicine has been generally slow to adapt to the electronic age, as reams of paper patient records can attest. But there are other reasons why doctor-patient e-mail has not become commonplace, said Dr. Michael Crocetti, a pediatrician at the Hopkins Children's Center and the lead researcher in the e-mail study.
Some doctors fear that parents will use e-mail in emergency situations. Or that it will lead to misunderstandings, on the part of doctor, parent or both, because tone and emphasis are so easily lost in e-mail. There are concerns about privacy, that a message sent to a nonsecure computer constitutes a violation. Some doctors fear that allowing patients to e-mail them would invite the presumption that they're on call 24-7. Others wonder whether they can be reimbursed for time spent sending e-mail. Or if moving toward that method of communication will lead to lower quality of care for poorer patients who don't have access to computers.

These questions loom so large that MedStar Health, which has six hospitals in Maryland and three in Washington, advises its doctors not to communicate with patients by e-mail.

But sooner or later, Crocetti and others agree, the e-mail revolution will come to medicine. And he believes patients and doctors will ultimately benefit.

"We have to embrace electronic communication in some way," Crocetti said. "We're going to need to figure out how to integrate it into the practice of medicine."

Some parents aren't waiting for doctors to figure it out. They're taking the initiative, asking doctors during office visits if they will accept e-mail, or shooting off messages without asking.

Mary Bonacci had an e-mail relationship with Crocetti even before he became her daughter's pediatrician. She manages the physician billing office for some Hopkins doctors, including Crocetti. So when questions about her daughter's health came up, it seemed natural to reach out to the pediatrician that way. And there have been plenty of questions over the years. Daughter Ava, nearly 6, was born with a fever and has been prone to very high ones — up to 107 degrees — ever since.

"If it's over 105 [degrees], I'm definitely in touch with him [by e-mail] every time," Bonacci said. "You send it off, and you immediately feel better."

In most cases, Crocetti e-mails back to ask if there are any other symptoms, such as stuffy nose, stomachache or rash. Usually there aren't, so he assures Bonacci that there is no need to go to the hospital.

"The e-mail has stopped us from going to the emergency room several times," she said. "You learn the pattern. You learn not to panic."

Bonacci has had less luck with her own doctor. She asked him a few years ago if he'd accept e-mail.

"He said he didn't do that," she said.

Not many doctors do, even though Crocetti's study suggests patients would be wildly in favor of it.

The study, co-investigated by Dr. Robert Dudas of the Johns Hopkins Bayview Medical Center and presented earlier this month at the annual meeting of the Pediatric Academic Societies in Vancouver, surveyed 229 parents of children seen at the Children's Center. Of that number, 171 described themselves as regular e-mail users. Of those, nearly 90 percent said they would like to use e-mail as a way to communicate with the pediatrician. Yet only 11 percent said they did so.

Dr. Scott Krugman, chairman of the department of pediatrics at Franklin Square Hospital Center, which is part of MedStar, is among those resisting that demand. The reasons range from patient safety and confidentiality to uncompensated care.

"Right now, our hospital policy is not to e-mail patients," he said. "We're not supposed to be doing it. And if you're going to do it, make sure it's encrypted. If the parent's e-mailing, they're probably not concerned, but from an institutional standpoint, it's a HIPAA [Health Insurance Portability and Accountability Act] violation and can be very bad."

He has about 700 patients. Very few — five or six, he estimates — e-mail him.

"It's a small number, and typically it's people who work at the hospital and have my e-mail address" from the staff directory, he said.

Asked to describe a typical message, he said, "Most common is, Dad's bringing the kid to the appointment and Mom e-mails me with the real information," he said. " 'They're coming for this, and I want to make sure you know this, this, this and this.' "

Krugman is concerned about the possibility that parents will e-mail him about emergency matters, assuming — wrongly — that the message will reach the doctor as quickly as a phone call to the office or answering service.

"If you send an e-mail to someone who checks their e-mail once a day, you could be in big trouble," he said.

E-mail can make it harder for doctor and patient to understand each other because they don't hear the other's voice, Krugman said. How anxious does the parent sound? How croupy does the coughing kid in the background sound?

"You can also reassure them easier," he said. "But with e-mail, they might not be reassured. They won't hear your tone."

Then there is the possibility that doctors will become swamped with e-mail and not be reimbursed for answering it. Most doctors aren't reimbursed for telephone consultations, either. But Krugman suspects that patients could get into the habit of dashing off an e-mail "on every little question," things they'd never dream of calling a doctor's office about.

Yet even Krugman thinks doctor-patient e-mail is on its way to becoming routine. "It's coming," he said.

Some patients are as leery as Krugman about that prospect. Among them are Shneara Sherman and Jaron Booth, who were in the waiting room at Crocetti's office one recent morning with their two children, 16-month-old Janasha and Jamillah, just 5 days old. They do not have a computer at their O'Donnell Heights home, and only occasionally use e-mail at a library or a friend's house.

"I don't check my e-mail often — maybe once, twice a month," Sherman said.

Not that Sherman is interested in e-mailing the doctor anyway. If she needed him, she'd rather get him on the phone so she could "ask more questions, get more information."

Crocetti expressed concern that patients without access to computers could lose out if doctors get away from taking phone calls in favor of e-mail.

"The last thing we want to do is inadvertently create a gap in access or communication between those who use e-mail regularly and those who shun it," he said. "And before we incorporate e-mail into mainstream medical practice, we need to factor in any racial, cultural or socioeconomic preferences."

And then there is the matter of just how doctors will manage the flood of e-mail eventually expected to come their way.

Entire books have been written about how calls to the doctor's office, or its after-hours answering service, should be routed. With e-mail, doctors are winging it — even those who, like Crocetti, are already swapping e-mail seem to have started without planning.

A parent asked if Crocetti whether he was available by e-mail, and he said, sure. Then another. And another. And on and on, until he looked up a few years later and found that 25 percent of his practice was online with him. And that's without advertising his e-mail availability to patients.

"The welcome packet [for new patients] doesn't say, 'Call or e-mail,' " he said.

The volume of e-mail has not been overwhelming for Crocetti, but he imagines it could get that way if he does not adopt a system for routing e-mail. In a group medical practice, doctors take turns being on call after-hours. If patients get in the habit of e-mailing their doctors directly, it's like being on call every night, "like a solo practitioner," he said.

He thinks group-practice doctors will eventually adopt e-mail systems that route messages to who is on call that night, so they take turns reviewing those that come in after-hours.

E-mail has already helped Crocetti avoid a lot of phone tag with parents. And sometimes it comes with photos that are the next best thing to an office visit.

"There's been a number of times I have parents that will say, 'My child developed this rash and here's a picture,' " he said. "It's been very useful."

Sometimes just before bed, Crocetti looks at his e-mail and will see something that merits an office visit. He'll shoot off an e-mail, " 'I need to see him or her,' I cc my scheduler — next thing I know, there's an appointment. For me, it works."

laura.vozzella@baltsun.com

Study findings

Two Johns Hopkins physicians, Dr. Michael Crocetti and Dr. Robert Dudas, conducted a study of parental attitudes toward e-mail access to their pediatricians. The findings were presented May 2 at the annual meeting of the Pediatric Academic Societies in Vancouver.

•229 parents surveyed

•171 described themselves as regular e-mail users

•Of the 171 regular e-mail users, 90 percent said they would welcome e-mail as a way to communicate with their child's doctor

•11 percent currently do so

•Parents of children with chronic health conditions were, for reasons not explained in the survey, less likely to favor e-mail communication. Of the 171 regular e-mail users, 33 percent had a child with a chronic health condition. Among these parents, 65 percent said they would strongly favor e-mail communication to improve management of their child's condition. Less than half from this group said they would be comfortable receiving test results via e-mail.

Source: The Baltimore Sun Health News

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