MRCGP Exam Update: Benefits of email consultations

Current situation

Current situation 

- Patients increasingly want to be able to communicate with healthcare professionals by email for various reasons.

- Email consultations could potentially play an important role in the delivery of preventive healthcare.

They could also facilitate self-management of chronic diseases.

- Use of email between patients and physicians is restricted by concerns on both sides over medicolegal issues, reimbursement, and time-management.

What is the evidence?

- There is very little evidence from controlled clinical trials to show whether the theoretical benefits of email consultations can be translated into routine clinical practice.

- Email consultations are still not commonly used.

A study from New Zealand found that the majority of GPs (68 per cent) had not used email with patients and of those who do only 4 per cent used it regularly (Inform Prim Care 2005; 13: 195-202).

- Email can broaden communication between patients and their dermatologist. An analysis of data from a single dermatology practice found 37 per cent of email correspondence related to a clinical question (J Am Acad Dermatol 2006; 54: 1,019-24).

- One study found that 63 per cent of people who sent in a query to a web-based answering service were women, with an average age of 32 years.

They were mainly seeking help in interpreting laboratory tests and information about infections and chronic conditions (Med Inform Internet Med 2007; 32: 123-9).

Implications for practice

- Teenagers and patients who live in remote areas may benefit from email consultations.

- Face-to-face visits and telephone consultations remain patients' preferred modes of communication for many healthcare issues, especially those thought to be complex.

- Technology is increasingly being integrated into modern clinical practice and it is important to be fully aware of the potential pitfalls it presents.

- Email may facilitate consultation with other physicians and the management of patients with chronic disease.

Available guidelines

- A guide to online consulting for GPs issued by the BMA in 2001 ('Consulting in the Modern World') warned that electronic communications systems could seriously damage the consultation process, increase workload and leave GPs open to legal action. It states that email exchanges are best suited to arranging repeat prescriptions or booking appointments.

- Currently, email consultations with unknown patients are considered unsafe and there are no agreed standards for such consultations.

Useful website

Consulting in the modern world - http://www.bma.org.uk

Key points

- Email consultations may be suitable for handling minor problems.

- They may not necessarily increase GP workload.

- Confidentiality is still a problem.

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