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This week s Wall Street Journal has two physicians debating whether the doctor-patient relationship should be extended to email. While both of these doctors agree that email correspondence can t substitute for an office exam, questions remain about whether this new channel of communication will create or quell confusion.

Dr. Joseph Kvedar, who does allow his patients to contact him via email, has found that it allows for a stronger doctor-patient relationship. Making himself accessible beyond the brief interaction of an office visit, especially when patients have trouble reaching him by phone, can make a difference. He says that email messages allow for clarification of instructions and for follow-up questions, all of which result in a written record that can be useful for a doctor s future reference. As for doctors who worry that opening up email communication will overwhelm the staff with more work, he points to studies that have found instead an increase in efficiency.

Dr. Sam Bierstock, however, is uneasy about extending email beyond the most basic of doctor-patient communications, such as scheduling an appointment and requesting a prescription refill. He fears that email communication between doctors and patients increases the possibility of misunderstandings and won t necessarily create a written record with any reliable accuracy. The ambiguities of an email message could make them easy targets for a malpractice attorney, Dr. Bierstock believes, exposing even the briefest email message to later scrutiny of its accuracy, thoroughness, and intentions.

But as ACSH's Dr. Gilbert Ross observes, There s little question that email communication between doctors and patients is becoming more widely used and accepted. Of course there are risks, both for medical miscommunication and for liability issues, but those can be countered with strict parameters about the kind of issues that can be addressed via email and the period of time during which they will be answered.