January 26, 2012
By Mike Krings
|Mugur V. Geana, MD, PhD. and K. Allen Greiner, MD, MPH|
Mugur V. Geana, MD, PhD, whose primary appointment is in the William Allen White School of Journalism and Mass Communication, and K. Allen Greiner, MD, MPH, professor of family medicine and associate chair for research, authored "You've got mail: Exploring patient-provider email communication in a primary care setting." Greiner will present the paper at a conference hosted by the International Communication Association and the French Society for Communication and Information Sciences in March in Roubaix, France.
Geana, a former primary care physician in Romania, and Greiner, a family physician licensed in Kansas and Missouri, and conducted an exploratory study examining 527 unique email messages from three general practitioners collected over 90 days. They removed all patient identification data and performed a content analysis on topics such as message characteristics, message content, content details, message tone, empathy and inclusion of other information sources.
"There were some very interesting findings in how practitioners use email versus how patients use it," Geana said.
He was most surprised to find that doctors took an average of 23 hours to reply to a patient's email, compared to about five hours for patients. However, they did not find any evidence of patients complaining about the response time. Due to the convenience sample, the findings do not have generalizable powers, but suggest that some doctors place less importance on email as a tool for communication or that patients generally understand that doctors are busy and can't always respond quickly.
"We did find that the more time it took the physician to reply, the lengthier of a response they gave," Geana said.
While patients didn't complain about response time, about 18 percent of their email messages did include complaints of some sort. Among the emails with complaints, nine percent were about the doctor, 13 percent about other medical personnel, 17 percent about their treatment, 61 percent about the evolution of their disease and 26 percent about other issues.
Treatments and lab tests were the most common topics of discussion for both patients and providers. Seventy percent of physician-generated emails were in response to a patient's message, while the rest were emails informing patients of appointment times, medications, test results and the like.
Doctors and patients also tended to focus on different topics in their messages. Among emails mentioning specific body parts or organs, patients were most likely to discuss issues involving the musculoskeletal system - 37 percent - while doctors addressed topics pertinent to internal organs most often.
Twenty-three percent of patient's emails were about medical problems of a family member or friend they were caring for. About a fourth of patients' emails included updates on their condition; the majority of the updates, 44 percent, stated symptoms had become worse, while 36 percent said they were improving and 19 said they had no noticeable change.
Although email software has been commercialized since 1988, Geana and Greiner write that it is estimated that less than 20 percent of primary care physicians in the United States regularly use email to communicate with patients, even though studies have suggested that it does improve patient-provider relationship and increases patient satisfaction.
"Patient to Physician email communication is slowly growing as a means of communication within health care. But it is still underutilized and not well integrated into electronic health records systems," Greiner said. "Many physicians are still resisting email interactions with patients out of fear of being overwhelmed by a large number of patients. This concern will only be ameliorated when the health care system moves from bricks and mortar, hospital-centered care, to more patient-centered approaches. Understanding the content of doctor-patient emails now, should help us build systems that take advantage of all new communication technologies."
The researchers hope to expand on the preliminary findings by using the data to drive research that will study both patients and providers to get more in-depth answers and shed more light on why they use email communications the way they do.
Geana and Greiner have successfully collaborated on a number of research projects over the past four years, evidence of the value of multidisciplinary work involving KU's Lawrence and Medical Center campuses.