December 9, 2014

Doctor-Patient Communication and the New Technology

In the good (?) old days, the doctor I saw most frequently was my internist. I saw him most often for my physicals. (Today many authorities question the need for and cost of those physicals.) We'd spend a relaxed half hour chatting in his comfortable office before I went next door to his equally comfortable examining room. There, he'd perform a general checkup and send me off for the blood work, EKG, and other tests.

Today, my internist has shifted to a concierge practice. I'd have to pay a $1,500 annual membership fee -- in additional to all the other regular costs -- to continue this pleasant arrangement. For this and other reasons, I ended our relationship.

Now, I usually find myself talking with a doctor in an office cubicle. No desk. Just a stand for the ever-present laptop. We're together maybe 15 minutes, and there's little idle chatter.

Electronic devices are everywhere in my health care these days. I was reminded of this reality during the past weeks, as I hired a new healthcare team. I was struck by the variety of positions these doctors took toward the use of email.

Email and Texting
I'm comfortable with using email and actually prefer it to talking on the phone. And either of those communication types seems better to me than being forced to make office visits when an information exchange is really all that's required.

Each of my doctors, old and new, has developed a different policy about email:
  • I was surprised several years ago when one doctor actually gave me his email address. I asked if I could brief him on healthcare issues electronically. He said sure but added he sometimes might not respond and would cut me off if I started taking too much of his time with my emails.
  • One of my new doctors said she won't use email because of concern about inadequate privacy protections for the patient,
  • Another doctor didn't give me his email address, but his assistant's -- who would acknowledge receipt of my notes and forward them to the doctor.
  • Several doctors restrict email use to brief communications about medications, symptoms, and appointments.
The current issue of the Harvard Health Letter has a quick-start guide to "Technology and your Health." It advises that patients need not be shy about asking for physicians' email addresses. They're handy for questions about treatments or prescription refills.

Texting is different since it's not always secure. The article advises that texts should never include personal information like birthdates or Social Security numbers. Email -- especially via website portals -- is considered more secure.

Website  Portals
Doctors and patients can obviously access accounts via web portals. And patients can ask questions, check lab results, request refills, and communicate with doctors there.

Your adult children -- or other trusted caregivers -- can also be given access to your medical information to stay current on developments concerning your health.

Electronic Records
All of the information once stored in paper folders -- medical history, lab tests, notes from office visits, medications, etc. -- is now stored electronically, available with a few keystrokes. The Harvard letter estimates that up to 50% of doctors now use these electronic systems, and the percentage is rising quickly.

Electronic records also make it easy for doctors to consult with each other about your condition. They can immediately share images -- CT scans and X-rays. As a result, diagnoses happen faster, and treatments come sooner.

Evidence suggests that electronic systems create "safer" care, since prescription medication errors from illegible writing have dropped up to 95%.

Mobile Health
Smart phones and other mobile devices -- tablets, laptops -- are now widely used by doctors and other healthcare professionals. And now there are thousands of health-related computer applications ("apps") that doctors and nurses can use on their handheld devices. Health professionals use apps to access the same information they can find on a computer (like medical records) or on the internet, (like guidelines and studies). These handy tools help physicians diagnose conditions, prescribe medications, avoid adverse medication interactions, and communicate with their patients and other doctors.

Patients can use apps, too. You can download an app and use it to communicate with your doctor or track your own health. There are simple apps, like calorie counters, pedometers, and medication managers. Some apps are more sophisticated, like those that help record blood pressure. Some apps require an accessory, like a blood pressure cuff that that plugs into your phone. That app can then transmit the information immediately to your doctor.

Just be careful about who gets your information. Use apps only from a known, trusted source or one approved by your doctor.

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