There is great interest in the general
population to seek out medical information online (8).
This trend can only be expected to increase, and rather than perceiving
this as a threat, it can be dealt with as an opportunity. Web sites
offer technology to allow patients to become educated, reduce the number
of phone calls and office visits by providing answers to simple questions,
and to search online for the medical solution and provider which best suit
their needs. Patients can be referred to online educational brochures rather
than having the practice purchase or print brochures. Guided tours of the
hand may be provided in waiting room or examination room on line kiosks
that the patient can browse unattended.
The larger potential involves integrating
patient interactions into a customer relationship management system as
described above, through which an automated system could allow new patients
to provide their initial medical history and insurance information, and
existing patients could double check their appointments, be reminded of
appointments by e-mail, submit requests for information, and deal with
their account information. Eventually, online video interactions may provide
additional flexibility for patient consultation.
Automated on-line interaction: The
number of patients seeking medical information online greatly exceeds the
number of physicians providing it (8).
Unfortunately, the ease with which materials may be published online allow
information of dubious value from unknown sources to be retrieved as well
as legitimate medical information. Patients cannot be expected to critically
evaluate the validity of materials they read online. Some physicians are
intimidated or irritated by patients who have done on-line research and
present it during an office visit for review. However, the most practical
response is to accept this, help patients recognize medical quackery, direct
patients to sites which are felt to be reliable, and when possible, contribute
high quality patient information on hand surgery online. A large body of
resources are available, some of which are detailed in Table
8. Some practices have found it helpful to provide online video brochures
regarding hand surgery (62, 48)
or apply an infommercial approach to specific procedures such as carpal
tunnel release (18). My personal experience
is that on line patient information is gratefully welcomed by patients.
They are a practical approach for a hand surgery practice, less cumbersome
than stocking a large number of different brochures, and can be expanded
or updated without limit.
Manual on-line interaction: e-mail
or other correspondence type communication between patient and physician
represents an entirely different situation with a number of issues
E-mail communication without any security
measures may be accessed by third parties, and confidentiality concerns
may outweigh the potential benefit of e-mail communication. Some
practices which initially had an open e-mail policy have discontinued patient
e-mail for this reason. The safest method is to use some form of
e-mail encryption, or make arrangements with the Web site server to provide
secure form based communications. The next best approach is simply to warn
patients that e-mail does not have guaranteed privacy and that such
communications are at their own risk.
E-mails between physician and patient should
be considered legal chart documents, and printouts of all patient
e-mails in and out of the office should be kept as part of the patient's
Medical malpractice carriers are developing
policies to deal with potential liability of medical e-mail (43)
The practice must have a clear policy not
only on maintenance of patient e-mail records, but a system to deal with
them. Physicians quite comfortable dealing with personal e-mail may
quickly find themselves overwhelmed with e-mail from their practice. Before
instituting patient e-mail, the practice should have a clear policy of
who will read the e-mail, who will answer it, when
it will be checked, when it will be answered, how different requests
will be triaged, and how each of these steps will be documented.
This policy should have the same degree of organization, documentation
and backup as the practice's telephone and mail policies.
The practice must have a clear policy for
management of emails arriving from unknown sources, such as solicitation
of medical advice by people who are not patients. Requests for medical
information can be stimulating and flattering at first, but can also easily
overwhelm the physician's ability to respond. If your practice site is
visible on search engines and you post an email address, requests for free
medical advice from persons unknown will arrive, even if your site
boldly states that requests for information will not be answered, or that
such requests should be directed to a local physician or to your practice
telephone, etc. How will these be handled? Should they be ignored? Should
they all be answered with a standard reply of "please contact a local physician"?
Should you review each one and decide how to respond? The obvious solution
is to handle these the same way that you handle telephone requests for
free medical advice - it is up to you, but the issue should be considered
and a policy outlined before listing an email address to the general public.
The practice web site e-Mail address should
be different than the physician's personal email address, even in
a single physician web site.
Email efforts are unpaid - currently.
However, given the increasing recognition of the demand and value of physician
on line consultation (42), there is
hope that a system for physician reimbursement for on line consultation
can be developed.