Electronic mail adds to successful practice
By Paula Hartman-Stein, Ph.D.
Douglas-Grossman-McKee, Ph.D., who
manages an Employee Assistance Program (EAP) at a large insurance
company in Cleveland, Ohio, spends two hours a day on 40 to 50 e-mails he
receives daily from employees he supervises and from patients.
Communicating with patients via email has become a mainstay part of his
practice during the past two or three years, according to Grossman-McKee.
“We use e-mails to respond to already existing patients in lieu of
phone calls, although we caution our patients that the system is not
completely confidential and can be monitored by the company,” says
Grossman-McKee. “Our medical
director feels this cuts down on unnecessary office visits and phone calls.”
His company is investigating a tool called Healinx that is set up to charge
for the e-mail interaction.
According to Robert Sigworth, M.D., a primary care physician from
Wooster, Ohio, e-mail is an integral part of his workday. His software program
allows him to send patients their test results directly and answer nursing
home phone calls and staff problems without interrupting time with patients.
A study published in the American
Journal of Managed Care (May 2002)* of two large primary care clinics
operated by the University of Michigan School of Medicine found that 61% of
the 126 physicians surveyed and 73% of their staff agreed that e-mail is a
good way to handle patients’ administrative problems.
An informal survey conducted by The
National Psychologist found that email is commonly used by psychologists
with adolescents and young adults. For example, Mark McConville, Ph.D. from
Shaker Heights, Ohio, uses e-mail when he thinks that creating easier,
user-friendly access for a young client will support the therapeutic
relationship, and teach him/her to utilize extra familial adult support.
The University of Michigan study
found that early adopters of e-mail are healthier, younger, better educated,
and less likely to schedule excessive clinic visits. Patient-provider e-mail
generated by the younger clientele may not substitute for visits and phone
calls, but instead increases the total communication workload for
practitioners, according to the study. As e-mail and Internet access expand
more broadly, the author predicts the profile of the users will change to
sicker and older patients who can start to use e-mail in a way that can
substitute for clinic resources.
The most common reasons for using e-mail with clients in the psychologist survey included setting up appointments, tracking progress of behavioral treatment plans, receiving parental updates about children’s behavior, and offering a venue for anxious clients to describe important events they want to discuss during an upcoming session.
Several psychologists screen and limit the clients with whom they share their e-mail address. For example, Shoshana Kerewsky, Psy.D., Assistant Professor of Counseling Psychology at the University of Oregon, noted, “E-mail is contraindicated in patients diagnosed with Axis II disorders.”
One important caveat given to
patients by most psychologists is to avoid e-mail in a crisis situation. Many
psychologists also reported they are guarded in their responses generally
because of concerns their correspondence could be used in a court related
matter in the future.
Worry about patient privacy was the number one drawback of
communicating with patients via e-mail. For example, Kerewsky uses e-mail
primarily for scheduling, “bearing in mind the upcoming federal regulations
about privacy from the Health Insurance Portabilty Accountability Act (HIPAA).
At the bottom of her emails she automatically cautions that e-mail is not
a secure or confidential medium, requesting that patients call her to convey
or receive confidential data.
What about patients? Do they
want e-mail access to their doctors? Survey results from 476 patients in the
Michigan study found that two-thirds of the patients would like to communicate
with their doctors via email, but less than 5% of all patients reported doing
Besides enabling more immediate
feedback to patients and cutting down on phone tag, on-line services are an
invaluable out-reach tool for EAP programs, according to Grossman-McKee. His
company uses online services for depression and anxiety screening and provides
psycho-educational information on stress management and other mental health
topics. “Instead of reaching the 3 to 5 % of employees that is typical for
EAP’s, our use rate is 15-20%. We feel that through the use of this
technology we are tapping into the estimated numbers of people with mental
*Moyer, C.A., Stern, D. T., Dobias, K.S., Cox, D.T.,
& Katz, S. J. (2002). Bridging the electronic divide: Patient and provider
perspectives on E-mail communication in primary care. The American Journal
of Managed Care, 8, 427-433.
Paula Hartman-Stein, Ph.D. is a clinical
psychologist, trainer, and consultant in Kent, Ohio. She can be reached
through her web-page, www.centerforhealthyaging.com
Hartman-Stein, P.E. (2002). Electronic mail adds to
successful practice. The National Psychologist, Vol. 11, No. 5, p 12-B.