COMPUTERS AND MEDICINE II: The Benefits Of E-Mail
A Journal of the American Medical Association article in the "Health Law and Ethics" section, authored by Alissa Spielberg of the Harvard Medical School, argues that "[i]ncreased use of e-mail by physicians, patients, and other health care organizations and staff has the potential to reshape the current boundaries of relationships in medical practice," forcing changes to practice standards and bringing forth new expectations and potential liabilities. Spielberg writes that despite e-mail's tendency to "seem troublingly impersonal [and] mechanical," it presents "a profound new social dynamic within the patient- physician relationship" that "will reshape the way basic medical care is delivered." She lauds e-mail's easing of access to communication "with minimal time delay," and adds that "[i]t also enables some reluctant patients to be more forthcoming and open." However, Spielberg warns that e-mail "may not be a satisfactory substitute for developing a more fully realized relationship," and raises potentially serious concerns over confidentiality and privacy. She concludes that e-mail "requires further examination and evaluation to develop practice guidelines for its reasonable use in medical settings" (JAMA, 10/12 issue). Two additional articles in JAMA address "The Orgin, Content and Workload of E-mail Consultations" and "Responses to Unsolicited Patient E-Mail Requests for Medical Advice on the World Wide Web."
A JAMA editorial by Dr. Tom Ferguson of the University of Texas Health Center noted that patients who venture online for health information would most like to see information from their own physicians. Ferguson thus calls for doctors to establish their own websites and correspond with patients via e- mail. He argues that the explosion in the number of online health resources at a time when only 1% to 2% of physicians have their own websites presages a time in the near future when "those who choose not to communicate electronically with patients may soon find themselves at a ... disadvantage" (10/21 issue). Speaking at a JAMA-sponsored forum for science writers at the Duke University Medical Center, Ferguson said, "The consumers are banging on the doors. People can make medical decisions if they're given access to the information." The AP/Winston-Salem Journal reports that Ferguson "is the publisher of an online medical report."
Speaking at the Duke conference, Thomas Eng of the Department of Health and Human Services warned that online access "remain[s] fairly unaffordable to many families," meaning that "[p]eople with greater health care needs are also less likely to have access to online information" (10/21). In a JAMA 'Policy Perspectives" piece, Eng and his co-authors wonder if online health information will be a "public highway or a private road." They conclude, "Both public- and private-sector stakeholders ... will need to collaboratively reduce the gap between the health information 'haves' and 'have-nots.' ... [B]y reducing the information divide now, the next century may bring us closer to health equality" (10/21 issue).
This weeks JAMA included two additional editorials:
- Dr. David Classen of Salt Lake City's LDS Hospital and Intermountain HealthCare wrote that clinical decision support systems will require deeper "involvement in the process of development, implementation and evaluation ... from medical schools and professional societies."
- Hubbs, Rindfleisch, Godin and Melmon wrote that doctors need to eradicate "avoidable ignorance" by utilizing medical information online, and called for the lowering of barriers to relieve deficiencies in standardization, computer hardware and Internet access (10/20).
More JAMA Articles
Other JAMA coverage on computers and medicine included articles on:
- Physicians "Using the Web in Clinical Practice";
- Using the Internet to globally monitor the spread of influenza;
- Using computer-equipped "evidence carts" on clinical rounds;
- Computer-based clinical support systems; and,
- Electronic information retrival systems