A new Medscape Business of Medicine article about whether and how physicians should communicate with patients by e-mail is instructive, although most of the issues it discusses were thoroughly hashed out years ago. Curiously, the article doesn't bring up the one new element of e-mail communications--the widespread use of mobile devices.
Among the topics the article does address is whether e-mail messaging reduces physician productivity; the lack of reimbursement for non-office-visit encounters; potential liability risks; how e-mail access to providers can grow a practice; the impact of e-mailing on the physician-patient relationship; and privacy issues.
In the latter area, there has definitely been a shift of attitudes in the past decade. One of the article's sources, Jason Mitchell of the American Academy of Family Physicians, says that, though the AAFP prefers secure messaging, ordinary e-mail is an acceptable option for patient-physician communications if both sides accept the risk. He also points out that many doctors would prefer not to bear the cost of secure web portals for this kind of messaging. In the past, experts agreed that physicians shouldn't utilize ordinary e-mail for patient communications.
As for whether or not patient e-mailing slows down physicians--an issue that the Medscape article presents in a pro-and-con discussion--that question was settled in a well-known 2005 study led by Eric Liederman, then at the University of California Davis. The study found that even among providers receiving two or more secure e-mails a day, 72% reported that integrating these messages into their workflow was "easy" or "very easy."
The Medscape piece notes that lack of reimbursement discourages many physicians from doing e-mail consults with their patients. That's one thing that hasn't changed over the years. In 2000, 10 percent of physicians said they e-mailed regularly with patients, whereas less than 7 percent do today, according to Medscape. But interest in e-mail consultations might increase significantly if and when physicians become financially responsible for keeping their patients healthy.