I thought it was about time to write a post about the woes of doctor-patient email.

Last week, a friend was having some issues with his phone, so his family doctor’s office couldn’t get in touch to inform him of the date of his specialist’s appointment. He didn’t know about the trouble until he popped in for a visit, which was when his doctor asked him – if he didn’t hear by a certain date – to call the specialist himself.

A good solution to the problem, but I couldn’t help wondering why email wasn’t an option. I mean, practices routinely collect our emails now, but I still don’t see them used very often. What if my friend kept having phone issues? What if he forgot to call?

Later, after the appointment had been worked out, he told me that the specialist ended up sending him an email with instructions on how to prepare for the procedure. This was appreciated, and got us both thinking about what exactly are the barriers to doctor-patient email.

What counts as private info? How do other providers deal with this around the world?

Let’s look at what’s out there.

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“Geography is destiny in medicine.” –Jack Lord, MD

In my undergrad English lit courses, I heard a lot about “character is destiny”. Which is a fancy way of blowing things out of proportion – e.g., Romeo and Juliet didn’t die via the quality of being “star-crossed”, but because they were super emo.

Well, this week, I watched a TED talk by Bill Davenhall (below) that claimed “geography is destiny”.

This idea is not so exaggerated. Just watch it (9 min.):

What it says: Where you’ve lived may determine how healthy you are.

There’s the classic equation:

health = genetics + lifestyle + environment

and of the three aspects, Davenhall argues that “environment” has been ignored for far too long by physicians.

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The same CBC article (on Canadian doctors’ love-hate relationship with EMRs) that featured Dr. Greiver’s EMR also published this comment that didn’t sit very well with me:

"Let’s be honest," says researcher Dave Ludwick. "Doctors have gone to school to become doctors, to understand how the body works and remedy that body’s failings, not to do IT. And yet with electronic records, IT suddenly becomes their job, too."

I am aware that this doesn’t exactly say that IT isn’t the physician’s job, but it’s certainly implied.

So what gives? Why the downer attitude?

If all jobs matched their job descriptions, the world would be a very foreign place.

Then I thought about the “description”…

In Canada, we have a famous diagram of the CANMEDS competencies (“a guide to the essential abilities physicians need for optimal patient outcomes”):

Indeed, our medical schools are crazy about this flower. Pre-medical and medical students do their utmost to present themselves as embodying these traits. You don’t get a more widely-accepted job description here than this…

And I think that every single petal is relevant to the EMR debate.

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The film “Up in the Air” is — ostensibly — all about George Clooney. Ryan Bingham (George Clooney) travels across the country 300+ days of the year and fires people for a living… Because bosses get scared and emotional ex-employees tend toward regrettable actions.

But “Natalie Keener” (Anna Kendrick) truly steals the show.

Natalie is the young hotshot character. She’s convinced Ryan’s boss to replace the guys’ jet-setting ways with New Technology: firing people over the computer screen. She’s going to make Ryan irrelevant, and the firees along with him.

Now replace “firing people” with “seeing patients”. Does the funny feeling grow?

This is the major reason “telemedicine” sets off alarm bells left and right.

We can accept pushing the “tele-” prefix onto other words. But not “medicine”. Medicine is sacred. Why? Because it should never be impersonal.

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Update (Jan. 15th, 2010): Thanks to Dr. Vartabedian (@Doctor_V) for featuring this campaign on his blog 33charts!

Here it is: I snapped a photo of the Privacy-In-Practice posters that University Health Network (UHN) has posted in its hospitals.

Looks like “Facebook, Twitter or blogs” are the big shots here. Do you think there are any other popular social media avenues that deserve to be listed as well?

For more information, see the post I wrote about seeing these posters for the first time last semester.