CardioExchange Archive

Picture this: It’s a usual Monday morning – one that involves trying to beat traffic in order to respond to pending emails and address administrative issues before the busy clinical day begins. Yet, prior to taking that first sip of much-needed caffeine, you receive an urgent email from a patient via your hospital’s electronic communications network. Five paragraphs later, you realize the patient is concerned about experiencing all the sides effects associated with statin therapy, two weeks after the therapy is initiated. Additionally, the patient feels he is currently taking too many medications, a conclusion he arrived at after reading information on the same secure website.

Six emails later – along with an extensive discussion, the distribution of pamphlets, and a total of three hours of electronic communication – you attempt to bring the patient in to review his case. He is reluctant, especially since you are unable to promptly answer all of his questions – a service that’s expected in today’s fast-paced information society. Finally, the patient comes in; after noting his history, conducting a physical exam, and asking focused questions, his symptoms are attributed to a viral syndrome that has abated.

This is not a made-up scenario or content for future coursework, but a true reality of the electronic communication system adopted by our industry. What started as a highway of free, abundant information to patients, along with the immediate electronic access to providers, has become more extensive than focused H&P examinations. The more we overwhelm the patient with medical information from different sources, the less focused the message delivered to the patient about the uniqueness of his or her condition will be.

The question remains then: Is electronic communication an expeditious method of healthcare delivery and does it really answer the health concerns of the patient? Or does it generate more queries due to the impersonal nature of digital messages, which are typically accompanied by either a paucity of information or a massive amount of data? Is the right financial course of action, during this era of budget constraints and limited reimbursements, actually hours of e-communication and the potential for legal action in the absence of a physical exam? Are we on the right path, especially when solidified guidelines based on the practice of telemedicine and the right advice when utilizing social media are lacking?

These are all unanswered questions, and yet true concerns remain as how to move forward in a society dominated by both e-communication and no single unifying idea as to what data is too overwhelming or too little for patients to understand. As the efficiency of this system is extremely debatable, since typically no digital conversations end with a single response, I believe we are not ready to move forward with email and web messaging as the primary source of communication with our patients. Unless we do the following: build the right data-sharing infrastructure, where the patient receives a focused message instead of the large medical data repository we call a pamphlet; develop the right guidelines detailing what constitutes as appropriate when using e-communication vs. in person; and standardize these rules across the industry, then our premature launch is a failure in the making. Though there are multiple of cases where e-communications have markedly and efficiently improved the delivery of care to our patients, all it takes is one case of a misdiagnosis or poor communication to demolish a system.