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Tech talking with your doctor

The era of "take two aspirin and email me in the morning" may not be here quite yet.

Most U.S. physicians -- including those on Long Island -- don't seem to be fully embracing the idea of regularly communicating with patients via email, let alone through texting on their cellphones, leaving phone calls as the best route for patients to contact doctors.

Three local doctors noted that while they don't text patients routinely, they do use email to hear from -- and respond to -- the people they treat. But they say email comes with practical limitations in areas like privacy, record-keeping and effective communication.

"It's a tricky thing," said Dr. Jeffrey Ellis, a dermatologist with offices in Plainview who's also director of dermatology for New York Hospital Queens in Flushing. "I'm a tech-savvy and technologically involved person, and I'd like nothing more than to be able to freely text and email patients. On the surface, that sounds only good."

Still, he said, it's not a simple equation.

Research on email

There's been little recent research into how often physicians use email to communicate with patients. A 2008 study found that only 7 percent of physicians routinely emailed patients. As for texting, researchers don't appear to have studied its use as a way for physicians and patients to communicate.

Dr. Sandy Balwan, an internist in Great Neck and an attending physician with the North Shore-LIJ Health System, said she doesn't text but will email patients on occasion. She doesn't think it's an ideal tool, though, because it "erodes some of the safety measures we put in place."

For instance, emailing allows patients to bypass what she called the "normal pathways" of her office's phone system, which is designed to provide immediate attention, if necessary.

When a patient calls in about a health problem, "it gets channeled to the nurse immediately and gets triaged to see if it can wait or if she needs to get me right away," Balwan said. An email, in contrast, may not be read immediately.

Also, she said, it's difficult to integrate emails into her office's record-keeping about the health of patients, and blackouts -- like those caused by superstorm Sandy -- can leave people without email. Still, Balwan said, she'll use email to communicate with patients who are hard to reach by phone.

Dr. James Capozzi, chairman of orthopedics at Winthrop-University Hospital in Mineola, said he'll sometimes talk to patients via email about things like basic lab results that don't require much explanation. But, he said, he prefers the phone because it allows more nuance.

"Sometimes, I'll hear hesitancy in their voice, and I'll explain it again," he said. "It's hard to get that interaction with texting or email."

On the other hand, Capozzi said, "if it's a patient I know well, and they're just sending a quick email saying they forgot whether I said hot or cold pack, that's an easy one."

Privacy concerns

Ellis said he worries about privacy and the lack of security that comes with email communication. It's possible to use protected or secure email systems to communicate with patients, he said, but his office has not yet used a secure system for that purpose.

A 2011 Kaiser Permanente study that examined communication between doctors and patients via a secure email system found that it's "been associated with a decrease in office visits, an increase in measurable quality outcomes (at least in primary care), and excellent patient satisfaction."

Ellis said patients can email his office to set up appointments, and he has used email to communicate with patients who are out of state and want to show him photos of a skin condition so they can get advice. In the future, he said, he hopes to use technology to more easily treat conditions remotely.

"It has tremendous value and power," he said.


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