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Trying to send your doctor an e-mail? Good luck with that

Toronto family physician Michelle Greiver says e-mail is ‘a very valuable addition to how we communicate with patients because it is so much easier for them.’

jennifer roberts The Globe and Mail

Have you ever tried to e-mail your family doctor to book an appointment, get test results or ask a basic medical question? If your doctor responded, you are among a very small minority.

Most Canadian physicians prefer talking to patients, face-to-face, citing confidentiality and legal concerns with using e-mail. And, many fear they will be swamped with requests and won't be financially compensated. Indeed, our doctors have been far less willing to embrace electronic communications than medical professionals in other nations, according to an international survey of physicians by the Commonwealth Fund.

Canada ranked dead last when it came to electronic access for patients, compared to 11 other high-income countries.

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Only 6 per cent of Canadian physicians allow patients to book appointments electronically, just 11 per cent refill prescriptions online, and only 11 per cent answer medical questions through e-mail.

By comparison, in Britain, 40 per cent of physicians said their patients could request appointments or referrals online; 56 per cent refilled prescriptions electronically and 35 per cent responded to patients' e-mail queries.

Dr. Tara Kiran, a physician and researcher at Toronto's St. Michael's Hospital, believes it's time for Canadian doctors to enter the modern era. In an article posted on the website, she pointed out that while social media have revolutionized the way we live and work in the past decade, the offices of many family physicians remain in an electronic dark age.

There are signs that attitudes are gradually changing. The general consensus among early adopters is that e-mail is good for patients – as well as doctors.

"It is really a very valuable addition to how we communicate with patients because it is so much easier for them," said Dr. Michelle Greiver, a family physician in Toronto.

She gets several e-mails a day from patients. In complex cases, Griever will tell them to come in to her office. But if the answer is straightforward, she just fires back a response. It means patients can get an answer within hours, rather than waiting days or weeks for an appointment.

"It seems ridiculous to make people take a half day off work to come in and see me for something that could be handled by e-mail."

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When Greiver first started using e-mail in her practice, almost a decade ago, she did the work in her own free time. She was paid on a fee-for-service basis and writing e-mails to patients wasn't covered by provincial health insurance. But since then, Griever switched to capitated payment – a relatively new system in which doctors receive from the provincial health-insurance plan a set fee per patient per year, regardless of the number of visits. "It now actually makes financial sense to e-mail patients because it's more efficient and saves me time," she said.

As the majority of physicians are paid on a fee-for-service basis, there is an effort under way to make e-mail a billable service – thereby making it more financially attractive for doctors.

"As we all know, whether we are in medicine or not, e-mail is another level of work," said Dr. Shelley Ross, a family physician and president of the British Columbia Medical Association.

She noted that the BCMA and British Columbia government recently agreed that doctors in the province should be paid for the time they spend talking to patients on the phone. It's part of a move to introduce more modern efficiencies into the medical system so that anyone who wants a family doctor will have access to one by 2015.

"Our plan is to see how well that [billing for phone calls] goes and likely move into the e-mail realm as well."

Ontario is also introducing changes incrementally. As of April 1, ophthalmologists and dermatologists are now paid for answering e-mail queries from family physicians seeking their advice on patient cases.

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The next step will be to compensate doctors for their time spent on e-mails with patients. Several pilot projects are under consideration, said Dr. Doug Weir, president of the Ontario Medical Association.

Weir, a psychiatrist who treats children and adolescents, already uses e-mail in his own practice. "It's how they communicate these days," he said, referring to his patients. And if doctors want to remain relevant, they too must move in this direction, he says.

There are, of course, potential pitfalls with a greater reliance on e-mail. Personal health information could easily go astray or be read by those for whom it is not intended, especially when a computer is shared by several family members.

"It's a very open medium," warns Dr. John Gray, CEO of the Canadian Medical Protective Association, which provides legal assistance to doctors. "I think there are a lot of physicians who don't realize they could run afoul … of regulations that require them to make sure that patient privacy and confidentiality are respected."

There are also concerns that a patient with a life-threatening condition may e-mail a doctor rather than making a beeline to a hospital emergency room. By the time the doctor reads the e-mail, it might be too late.

To safeguard the health of patients and protect doctors from potential lawsuits, experts say physicians need to take some precautions. Automated replies should clearly state that e-mail communication shouldn't be used for medical emergencies.

St. Michael's Hospital in Toronto, for instance, recently produced a set of guidelines that require patients to sign a consent form before they can receive e-mails from staff of the medical centre.

Going through some red tape may be just one of the small prices you'll have to pay for the benefit of e-mailing your doctor. Patients who can already do it praise the convenience.

Cheryl Sleep used to live in Toronto and was a long-time patient of Greiver. A few years ago, she and her husband retired to Prescott, Ont., which is 360 kilometres east of Toronto.

Sleep kept Greiver as her primary-care provider, staying in touch through e-mail. That online connection proved to be helpful when Sleep's elderly mother recently came to stay for an extended visit. Within days of arrival, her mother fell and broke a collarbone.

"Dr. Greiver is my mum's family doctor, too," said Sleep. "So I would e-mail her and she advised me what to do" during the recovery period.

"It is such a relief to know if I need something, I can e-mail her and she gets back to me within 24 hours." That's certainly better than a long car drive to Toronto.

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