Personal Health Navigator

Why many doctors won’t email patients – and how that could change

doctor typing on laptop
Written by Paul Taylor

Question: I have a simple health question that I want to ask my doctor.  But his office says I have to book an appointment to see him in person. Why can’t doctors be like everyone else and send emails?

Answer:  It’s true that the medical profession can sometimes seem stuck in the past. Just consider the shocking estimate that two-thirds of Canadian physicians still rely on archaic fax machines as a primary means of communicating with other health-care providers such as specialists, pharmacists and hospitals.

When it comes to their own patients, many busy doctors are reluctant to start using emails, partly because they’re concerned about finding themselves on call 24/7.  Another disincentive is the fact that most provinces and territories don’t pay physicians for doing emails – British Columbia is the notable exception.

Even so, some doctors see advantages in communicating with patients through email.

“It’s easy for patients, and often times it’s also easier for physicians,” says Dr. Sharon Domb, a family physician at Sunnybrook Health Sciences Centre in Toronto.

But, she is quick to add, “doctors have to follow all kinds of regulations and that’s where the whole system becomes troublesome. “

First and foremost, physicians are responsible for safeguarding patient privacy – and emails are vulnerable to hacking or being misdirected.

The Canadian Medical Protective Association, the body that provides physicians with legal support, warns doctors that they need to have a discussion with their patients about the potential risks of privacy breaches. It also advises that patients should sign a consent form, acknowledging the risks, before any emails flow back and forth.

To further complicate matters, many of the provincial and territorial bodies that regulate doctors stipulate that electronic communications need to be documented in patients’ medical records.

“Where possible, it is advisable to copy all email correspondence for the chart, particularly those dealing with matters of significant clinical impact,” says a policy statement of the College of Physicians and Surgeons of Ontario.

Yet, Dr. Domb points out that it can be time consuming and cumbersome to attach emails to a patient’s medical record.

All told, much stands in the way of electronic messaging. But a pilot project, underway in Ontario, aims to remove the key barriers.

The pilot is being run by the Ontario Telemedicine Network (OTN), a not-for-profit organization funded by the provincial government.

“We are trying to come up with a strategy that will help doctors do this – and do it in the right way,” says Dr. Ed Brown, OTN’s Chief Executive Officer.

A key component of the pilot is an app that enables patients to send secure text messages to their doctors from smart phones, tablets or computers.

The physicians can then text back answers. “If doctors think a question needs more explanation, they can do an audio call or book time for a video call,” says Dr. Brown.  The app also makes it possible for doctors to send prescriptions directly to pharmacies and order lab tests for patients.

Doctors are paid $15 by the pilot program for a completed text transaction. If they have to do a video chat, the compensation is equal to an office-visit fee – which can vary depending on the nature of the appointment.

So far, the pilot has recruited 275 physicians who, in turn, have enrolled 29,000 of their willing patients.

Dr. Brown said the messaging system is not meant for urgent matters or medical emergencies. “I think people recognize pretty clearly that it’s not for complicated things, but used appropriately, it is a fabulous tool.”

Of course, important details still need to be worked out before the pilot goes mainstream.  The texting system must be integrated into physicians’ electronic medical records – and that’s challenging because doctors are using different systems. What’s more, a flat fee may not be the best way to compensate all doctors. (Some physicians are essentially paid a salary based on the size of their practice and the demographics of their patients.)

Dr. Brown notes that groups of Canadian physicians have recently established online services  (such as www.getmaple.ca ) which provide medical assistance – and some patients are apparently willing to pay for the convenience.

But Dr. Brown would prefer to see patients connect with their own family doctors because that’s the best way to ensure consistent medical care.

“Virtual technology is going to have a big impact on the future of medicine.  And right now, we’re in a race to empower primary-care providers so that they can make electronic messaging a part of their normal practice,” he says.

“We hope the pilot will help us work through some of the issues holding it back.”

Dr. Nihal El Khouly, a family physician in Bolton, Ont. has volunteered to be part of the project. “We need to be innovative and this is one way we can give better access,” she says.

She notes that many of her younger patients want to be able to communicate with her electronically.  Meeting those needs, however, can potentially add to a physician’s workload.

So, she says, it’s important to manage patients’ expectations and make sure they are aware that it may take a while for her to respond.

Dr. El Khouly usually reviews her messages once a day to see if a patient has a request needing relatively prompt attention. She deals with most of the questions in an hour that she sets aside once or twice a week.

“The patients love it,” she says.  For some, it means they don’t have to book time off work or arrange for daycare because an office visit has been avoided.

Aside from benefiting patients, the messaging system can help doctors do their jobs.

Dr. El Khouly says she recently had to contact a patient after obtaining the results of a medical test. “I had to see him urgently. So, I requested a visit with him (through the app) and he responded immediately.”

It also enables physicians to use their limited time more efficiently.  “By dealing with the minor concerns online I am freeing time in my office for complex patients,” explains Dr. El Khouly.

About the author

Paul Taylor

Paul Taylor, Sunnybrook’s Patient Navigation Advisor, provides advice and answers questions from patients and their families, relying heavily on medical and health experts. Email your questions to AskPaul@sunnybrook.ca
and follow me on Twitter @epaultaylor