All of the discussion of technology, privacy, time constraints, liability and sociological trends is missing the real issue: doctors can't afford to provide uncompensated services.

Insurance payments are tied to services provided in the office, face-to-face. Anything else is free. Why should a highly trained professional with big overhead expenses runnning a small business give away his/her expertise?

Those doctors who do it generally are going to be salaried employees of university hospitals (e.g. Beth Israel Deaconess in the article) who have no overhead and get paid regardless of how many patients they see, staff model HMOs (which have an incentive to reduce, not increase patient visits) and "boutique" providers who charge patients an annual fee to cover these uncompensated services.

> you'll just have to get used to your doctor not answering your email.

Oh, posh. :) Some bloggers will stop at nothing to get me to curse, but it won't work this time.

Fellow patients out there - THINK: you do have a choice. My primary, my oncologist, my orthopedist, my urologist - all reply to my emails. (They're all at Beth Israel Deaconess Medical Center in Boston, but that's not the only place that's like that.)

Three of the four use PatientSite, the hospital's secure email system (sort of like using email on your bank's web site). But even without that, it's really wonderful to get this form of support.

Your doctor may appreciate knowing there are precedents and well established guidelines:

• an article from the American Medical Informatics Association.
• The AMA has published Guidelines for Patient-Physician Electronic Mail (H-478.997)
• This page has several other references.

Print, snip & save. :)

YOU DO HAVE EVERY RIGHT TO REQUEST THAT YOUR DOCTOR COMMUNICATE IN A WAY THAT WORKS FOR YOU. And if they decline, you have a right (if you wish) to find a doctor who will. Just ask. Some do, some don't.

p.s. Please also be aware of the Patient-Centered Primary Care Collaborative, which, among other things, is working to let doctors *be* paid for time spent in communication, both by email and phone. PCPCC appears to be a very good group, fighting for changes to let doctors actually spend time taking care of you.

Really now. Shall the doctors also be tied down to computers? My spouse is constantly paged all hours of the day and night and answers calls promptly. There is NO reimbursement for these calls, unlike the fees attorneys charge for calls. If you wish for your doctor to be on her/his toes, then allow them to also take a bit of a rest. A phone call is enough, without having to be concerned with responding to emails. Further, whatever is promised about online "confidentiality," most are aware of the frequent breaches. I would not want my family's medical information hacked into, or printed out by a doctor's office employee for whatever purpose. Yes, it DOES happen. Technology is good; however, NOT in every area of life.

I'm a family medicine resident who MUCH prefers email to phone for non-urgent issues. I even started a blog as another means of communicating with patients.

I harbor the suspicion that many doctors don't want to use email because they type slowly! But I agree with the article - it's only a matter of time 'till email is the norm.

I have two reasons why I prefer to communicate with patients via email rather than telephone:

1) It is more efficient. Both patients and I have complicated schedules and it is frustrating to play phone-tag.

2) It is a competitive market place and I feel that by providing better service (communication), I can compete better.

It certainly isn't for everyone. But I feel it is the direction we are heading. Particularly with the convergence of the phone/text/email/PDA/beeper.

I'm compiling a list of articles on this topic (here's the post that hooked me in anew).

I'm interested in medical journal articles (which I suspect will be the most influential among health professionals) as well as popular press accounts (like this AP story, which reach the rest of us). You can email me at sfox(at)pewinternet(dot)org.

It is very interesting to see that the MDs writing in support of email exchanges are clearly adopters of social networking technology, writing very active - and very interesting- blogs.

Inversely, the MDs against the use of email with patients do not seem to have understood that, in the world we are all developing together, medical knowledge is a network (one of the principle of participatory medicine).

Soon we will start real large scale implementations of PHR. When this happens only the doctors who have developed or transformed their practice to actively use email communication (or other forms of secure electronic communications) with their patients will be competitive!

No one has mentioned the other side of "E" mailing your doctor. By calling the office the doctor can take the phone if he-she is able to according to time constraints--get the problem solved, or ask that the patient come into the office, and pass the phone to the assistant to make an appointment. If a doctor gets an "E" mail from a patient who may have a crush on them, where does the "E" mail stop?

One reason that physicians won't send answers by e-mail is because they look upon everything as a risk for a lawsuit. Change the malpractice climate in our country and physicians will do a lot of things that will simplify communication and many others that will help to keep the cost of medical care down.

Hi, I'm a current senior high school student, and I’m doing a research on Universal Health Care. I would like to take just a few minutes out of your free time to ask you a couple of questions. Please reply as soon as possible to my e-mail below.
Thank-You,

Do you personally agree or disagree with consumer-direct health care reform?

Would consumer-direct insurance allow the people to buy insurance from other insurances?

80% of health costs contribute to preventable diseases, why doesn't the government focus on preventing diseases instead of cures? (In your opinion)

Should health care be a basic right?

Is health care something the U.S. should be focused on?

Why do most doctors change their work field? Does med school factor into the shortage of doctors we have?

I think that the best way with a doctor is telephone not email. Even I do not understand people who contact their doctors via email.