Take Two Pills and Skype Me in the Morning

A growing number of patients are emailing and texting their doctor to let them know how they're feeling.  Doctors and patients who travel out of town are Skype-ing to stay in contact.  I know of patients who have developed rashes after starting a new drug who have emailed a photo taken on their smart phone to show the doctor what the rash looks like - allowing a diagnosis and treatment without requiring the patient to make an appointment.  I know of physicians who have emailed photos of rashes so that the dermatologist can see what the rash looks like in case it looks different by the time the patient receives an appointment.  I've heard of at least one pediatrician who put his email address on his business card so patients can use it when necessary.  I know a doctor who talks to a patient in the office and puts family living in another city on speaker phone so they can listen in to what the doctor is saying.  And I know of at least one hospital in the US that has a set up that enables doctors and patients to communicate by video link. 

The trend towards smart phones is definitely being driven by MDs.  Surveys show that while 20% of the general population uses smart phones, the number rises to between 72 and 94% when you're talking about physicians.  In August 2010, every first-year medical student at UC Irvine and Stanford received a symbolic white coat and was also given an iPad.  But it's patients who are demanding to use smart phones to talk to their doctors.  A poll in the US of more than 1600 parents showed more than half of them would find electronic communication with their kid's physician.  However, the same survey found that ess than 15% of those parents were actually able to communicate electronically with their child's pediatrician or GP.  Patients who email their doctors apparently see benefits,according to recent US data.

Doctors use their cell phones to talk to patients all the time.  Some of them block their number so it doesn't appear on call display.  When it comes to email, texting and sending and receiving medical information, they're a lot more reluctant.  One reason is privacy.  Many MDs are concerned that electronic communcation (messages with or without attachments like ECGs, x-rays and photos) could be intercepted by a third party with the doctor being held liable for breaching patient confidentiality.  Some doctors fear they'll misdiagose a rash seen on a smartphone display.  Or, they feel they need  the patient right in front of them to make the diagnosis.  Doctors also aren't sure what the rules of conduct are.  If a patient sends an email at 6 pm this evening, when is it reasonable for the doctor to reply?  What if the patient sends five emails in one evening? Another reason has to do with payment, since provincial payment schemes pay little if anything for telephone advice. 

There are no universal guidelines yet for electronic communication between physicians and patients.  For now, the doctors who use it have restricted it to patients with whom they have already established a relationship.  In other words, they think of it as an updated version of a phone call.  You don't give advice by phone to a patient unless you know them or you're on call for your colleague and have access to their chart.  Electronic messaging in not a replacement for a doctor patient visit.  At least one hospital in the US has gotten round the privacy and security issues in videoconferencing by using a system called called WebEX.  That system gives access to doctors at the hospital by out of town patients but requires them to use an access code and password.

Assuming they work the bugs out, what happens next is so cool!  If the family doc or OB has a patient in labor, they can use an app called Airstrip OB to monitor their patient at the hospital from across town or around the world.  We'll be able to a get patient with asthma to blow into a device connected to a smartphone loaded with an app called to see how well their asthma is doing.  When I work in the ER, I'll be able to scan each patient's bar code into my smart phone and instantly have access to their electronic hospital record which will be integrated with their record at the doctor's office.   If I have a patient who doesn't speak English, I'll open up an app that acts as a speech-to-speech translator so I can take a history and discuss the treatment plan.  Because it's my smart phone, I'll save time by not having to log in to a new computer in each room or building I enter.  I'll stay logged in the whole time and have everything I need including medical charts, diagnostic references and texts for ER, drug references, web browsing, medical calculators, translators, patient education materials, and a host of specialized applications) in one place on my smart phone. 

Privacy is a serious issue.  But the future is too enticing not to overcome any obstacles.