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Does The Convenience of the Net Help or Hurt Medicine?

To control costs and optimize operations, some medical groups and health plans now offer a faster and often less expensive means to dispense medicine to patients: Via e-mail. Although, in some cases, computer-literate physicians have been communicating informally with their patients like this for years, now a few plans will pay doctors for their time.

For example, one health care insurer, Blue Shield of California, pays physicians the same amount ($25) each time they consult with a patient in person or by e-mail. On the other hand, patients are charged a $5-10 co-payment that's billed to their credit cards.

The advantages are obvious:

  • Doctors can offer advice about postsurgical care, diet, changing a medication and other topics that can be handled safely and promptly without an office visit or a frustrating round of telephone tag.
  • Patients can visit secure, password-protected Web sites to get X-ray and test results and request prescription renewals.
  • Surveys have shown e-mail has reduced the number of daily office visits, giving physicians more time to spend with patients who need to be seen.
  • The convenience of e-mail allows patients to send medical questions from home or the office without missing work or killing time in a waiting room.
  • Patients who communicate with their physicians this way may feel closer to them, as a result.

For patients, e-mail allows them to send their medical questions from home in the evening, without missing work and spending time in a doctor's waiting room. In fact, many say exchanges in the more relaxed, conversational realm of e-mail make them feel closer to their doctors.

Like most aspects of life this technology can be a mixed blessing. On the one hand, I am delighted to see that third-party insurers are actually recognizing that e-mail communication is a valid and reimbursable patient interaction. Overall, I do believe it will improve the overall quality of medicine. There are some technological safeguards that need to be implemented to preserve patient privacy but this is easily done.

However, like everything in life, it needs to be balanced with real live time. The practice of medicine is a more interactive process. A good doctor relies, not only on what a patient tells him, but on the details his keen eye observes. In other words, what a patient may be telling his doctor may be a far cry from what's really happening. Then again, is it a waste of a patient's time in a doctor's office if one has a question about a chronic condition that merely requires a one-sentence answer?

You be the judge.

New York Times March 2, 2005

The (Lakeland, Fla.) Ledger March 2, 2005

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