Academic journal article American Journal of Law & Medicine

Online without a Net: Physician-Patient Communication by Electronic Mail

Academic journal article American Journal of Law & Medicine

Online without a Net: Physician-Patient Communication by Electronic Mail

Article excerpt


Patients continue to find new ways of reaching their physicians. In the past, patients and their health care providers developed relationships through the course of everyday affairs and across a wide variety of social exchanges. Although other methods of communicating were introduced into the medical context, telephones, pagers and voicemail all retained some connection to individual voices. Moreover, medical practitioners and patients alike never anticipated that these technologies would substitute for genuine personal interactions. Nor did they anticipate that another new technology, electronic mail (e-mail), would shift communications back in time to the days when letter writing formed the basis for diagnosing and relating. E-mail in medical practice has already begun to reconfigure the patient-physician relationship in the electronic age.1

This Article will discuss the rights and expectations of patients and physicians when they communicate electronically. Part II describes the historical context of electronic medical communication. Part III reviews current practice standards for medically related communication. Part IV discusses the inclusion of medical communication documentation in the medical record. At the intersection of several legal fields, electronic communication by health care providers and patients implicates a variety of legal concepts. Part V assesses the current law of medical information privacy and physicians' duty of confidentiality as these principles inform clinical e-mail use. Additionally, Part VI argues that existing informed consent standards likewise apply to medical e-mail. Part VII analyzes the relationship between medical e-mail and existing and developing telemedicine law. Part VIII explores newly emerging government and insurance industry proposals for integrating electronic communication into standard practice. Finally, this Article considers practical suggestions for the use of medical e-mail.


Electronic communication in medicine is an outgrowth of technological innovation and social custom.2 Until recently, medical practitioners, patients and insurers communicated solely by postal mail, telephone or in person.3 Indeed, early American medicine was practiced predominantly in person or by written description delivered by courier or mail.4 During the seventeenth and eighteenth centuries, physicians valued patients' descriptions of their illness above a physical examination when making medical diagnoses.5 By the middle of the nineteenth century, however, physical evidence determined medical conclusions; thus, physicians needed to examine their patients to make accurate diagnoses.6 Physicians traveled to their patients' homes and, after 1843, could consult, again in written form, by telegraph.7

The telephone dramatically altered the patient-physician relationship soon after its invention.8 Despite some trepidation about using the telephone for such personal matters, patients quickly accepted the technological exigencies in order to receive better medical care.9 Once patients believed that telephone lines were secure, they became increasingly dependent on the telephone for medical consultations, particularly in emergencies. 10 By the mid 1960s, telephone communication routinely supplemented face-to-face appointments and facilitated health promotion by allowing people who could not travel to access to medical care." I By retaining a live connection to individual voices, the telephone was "the next best thing to being there."

Communications in the health care industry generally were augmented and facilitated by computer-based information networks.l2 Health information networks emerged in the 1960s, first for bibliographic and academic purposes and later for public health data tracking and health organization internal record keeping.13 Electronic communications among health organizations were virtually unknown during the following two decades. …

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