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 so.  

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 health problems.”  

*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.