How email can improve doctor-patient communication

Many people are worried that email will harm the doctor-patient relationship by making it impersonal. However , I often find email helps to improve it ! In fact, email is a great way of communicating with patients. Face-to-face, many patients go to pieces. They forget their questions; garble their medical history; and often forget half of what the doctor tells them when they leave the clinic.

However, when they send an email, they have a chance to compose themselves; think about their patients; edit their responses; and ask a friend to help them with their queries.

A good doctor will help them send informative emails by providing them with a structured form, so they can provide the medically important information which the doctor needs ( so he does not need to extract it every time by grilling the patient).

Morever, since email is free and avoid telephone tag, patients are much more relaxed when they have an email-friendly doctor.

In fact, I tell all my patients that email is my preferred mode of communication. While I am always happy to talk to them, this is much more effective for everyone, since it cuts down on commuting time and they don't need to wait in my reception area.

Even better, everything is documented and in writing, so there is no scope of confusion or errors. This is much better for patients - and for doctor, because I don't need to keep on repeating the instructions. And in case there is any confusion, I can always clarify it.

Since so many of the questions most doctors receive are so similar, it's easy to define a list of FAQs. I can polish my answers to these FAQs, until the replies are crystal clear - saving both me and my patient a lot of time and distress.

Some common-sense tips for using email.

Include a short history, so the doctor knows who you are. I tell my patients to scan in the consultation sheet, so it's easy for me to place their questions in context.

Provide as much information as possible . It's better to provide information which may be irrelevant - he can always skip this

Include the earlier emails in your replies, so the doctor can refer to them as needed

Make your question as specific and detailed as possible. This helps to minimise the amount of typing the doctor needs to do. The most considerate patients are the one who frame their questions in such a way that I simply need to answer - Yes or No . I appreciate these patients, because they value my time and don't tax my ( one-finger) typing skills.

I also prefer email because I can provide more thoughtful replies. For example, I do have bad days, and if I am irritable and angry, I might upset a patient if they ask me questions face to face with my unfriendly body language ( which is a result of my bad mood, and not because I am upset with the patient). However , when I answer queries by emails, I can be much more objective and empathetic.

Yes, email does help me to empathise with my patients. This is not very intuitive, so let me clarify. A patient sitting in front of me may not feel comfortable enough to complain; or she may be so concerned that I am very busy, that she may not talk to me about issues which are important to her, but which she thinks may be "trifling " and medically unimportant . With email, she does not have any contraints, so it is much easier for her to "pour her heart" out.

Here's an example of an email I recently received.

" Dear Doctor, It was so kind of you to have called back on my mobile number, unfortunately I could not take the call as I was in an important meeting.

I called your clinic thrice after that and was told you were in the consulting room and would call back after 6pm. I'm not sure if you received my distress messages or not.

To brush your memory: we had to cancel the injections for ICSI on me in this cycle on Day 4
because of the abnormal prolactin level - 173 ng/ml. You had advised Cabgolin. The whole thing was quite unsettling and therefore I had a repeat test from a reputed lab - SRL Ranbaxy.I received the report last night and the level shows normal at 3.7!

I don't know where your clinic sends the blood samples for tests but wherever it is, it apparently has made a huge mistake and I had to pay a huge price for it. I am upset and low: I have lost a cycle, lost money (Rs 5000 ) and have undergone mental and emotional trauma with the prospects of probably having a tumour of all the places below the brain, and that too, inside the
skull. The whole episode from the time you said, "Why is your Prolactin level so high?" till yesterday was traumatic. I didn't just lose one cycle... till the time my prolactin levels would be back to normal, my dream of holding my baby in my arms would be further too. You know what, I see only babies all around and both envy and marvel people who have one... most of
them have two!

Please do not construe what I've written above or write below as a complaint. I'm just stating it as a matter of fact. I trust you as my doctor and have entrusted myself to you, to help my husband and me to have a baby, and by that token, I think it is my responsibility to bring this to your notice as well as voice my concern.

I am wondering why my prolactin tests were not tested before I was put on any medication or before we began the injections? I am wondering why the blood sample was not sent to a reputed lab like Ranbaxy (which you have twice earlier advocated to me)? I am wondering if
there is something else which might just erupt (a blood test maybe) and necessiate aborting another cycle? ...I am wondering so many things Dr Aniruddha !

I am concerned. Please assure me I'll be taken care of well.

Please advice on the next step for me. Should I need to take Cabgolin? How do we proceed further on my treatment? Shall we "ready, steady, go" in the next cycle?

I'm totally confused and lost, and not being able to talk to you today added to my confusion. What is the best time to talk to you? I would respect your time and never call other than the specified time."

Such a marvellous and thoughtful email. She would never have been able to tell me all this sitting in front of me - and I would never have guessed what emotional turmoil a falsely elevated prolactin level can cause a patient. I promptly called her back and explained to her that prolactin is a "stress" hormone which can get transiently elevated even as a result of the stress of undergoing a venepuncture for the blood test. I could reassure her that this was not something we need to worry about in her case , since her repeat level was normal; and that we could proceed with treatment in the next month.

Even more importantly, she opened my eyes to what many of my other patients ( who are much less articulate) must be going through when they get an abnormal blood test report ( which to me is a "routine" affair) . I can hold their hand much more effectively, now that I know what they must be going through. Her feedback has also helped me improve my clinical protocols, because she reminded me that all abnormal blood tests need to be re-checked for confirmation before taking action on them.

Far more importantly, the next time she comes to my clinic, I will treat her with a lot more respect and care, since she was so helpful in providing valuable beedback