October 1, 2006

Electronic patient-physician communication

Mandl, Kenneth D., et al. (1998). Electronic patient-physician communication: problems and promise. Annals of Internal Medicine, (129)6, 495-500.

This article outlines pros and cons of electronic communication between physicians and their patients and provides a research agenda to help shape the communications infrastructure in this setting. While the authors believe that email offers opportunities for better communication, they are also wary of potential drawbacks. Either way, they state, linking patients and physicians through email “may have profound implications for the patient-physician relationship� (p. 495).

Potential advantages of email communication include:
• Increasing access to care
• Enhancing patient education
• Augmenting screening programs
• Improving adherence to treatment plans

Potential pitfalls include:
• Use of email may be inappropriate in some situations, such as diagnosis of a new problem, addressing urgent needs, or conveying sensitive issues
• Concern over security and confidentiality
• Medicolegal liability
• Inequitable access to technology

Prior to widescale acceptance and availability of electronic communication between patients and physicians, the authors argue for the following to be addressed:
• “Define appropriate use of the various modes of patient-physician communication
• Ensure the security and confidentiality of patient information
• Create user interfaces that guide patients in effective use of the technology
• Proactively assess the medicolegal liability, and
• Ensure access to the technology by a multicultural, multilingual population with varying degrees of literacy� (p. 495).

September 2, 2006

The Medical Journal Meets the Internet

Curran, Charles. (2002). The medical journal meets the internet. First Monday.

This article examines the ways in which the internet has the potential to change the field of medical publishing. The internet offers major time and cost savings, as well as media enhancements such as video clips and hyperlinks; however, these changes are not without concerns. Curran outlines the advantages as: streamlining the various steps of manuscript review through electronic communication, as opposed to conventional mail, and cost reduction of production and distribution of journals, in addition to providing reduced journal storage volume in libraries and increasing breadth of access to new information (through e-searches). Convenience is another advantage of e-journals: convenience of being able to search articles electronically, rapid access, and downloading of articles. One disadvantage is the need of internet infrastructure, which may be not as readily available in developing countries. In addition, although savings of cost and time are important, the author argues that the tenants of rigorous peer review must be maintained to ensure scientific scrutiny of clinical studies. Time is still needed for peers to review the validity of claims made in clinical study reports prior to publication. Finally, the internet could also help balance “publication bias,� where results not found to be statistically significant are not published. Curran argues that the internet will allow for greater publication of negative or statistically insignificant findings, important information in meta-analyses and to prevent unnecessary duplication of clinical studies, as the internet is less hampered by traditional publishing costs.

Curran’s examination of the internet’s influence on medical publishing highlights three key areas identified by Gurak (2001): speed (in the reduced time in brining first submission of a report to its publication as well as reducing the time of bringing medical advances to the practicing physician), reach (bringing greater and easier access to consumers as well as those in the medical field), and interactivity (the ability to conduct electronic searches and the potential of including multi-media enhancements to journal articles). This study remains relevant today, with the NIH, the major funder of medical research, mandating more rapid communication of research findings to the medical community and to the public.

The Healing Web

Bresnahan, Mary Jiang & Murray-Johnson, Lisa. (2002). The healing web. Health Care for Women International, 23, 298-407.

This study focuses on CMC of social support in an electronic health discussion group centered on menopause. Using Goldsmith and Albrecht (1993)’s social support as the theoretical background, the authors define social support as “the sense of well-being and comfort that women derive from participation in a discourse community devoted to health issues as well as the specific interactive exchanges with other participants that are used to conduct social support� (400). According to most social support models, effective support must be based on face-to-face interaction. The authors set out to test this. They examine data from a listserv, asynchronous women’s health discussion group comprising several hundred participants; using content analysis, two thousand messages were coded for thematic content categories. Three “content areas� emerged:
• communication problems with physicians;
• problems experienced with hormone replacement; and,
• discussion of alternative treatments.
In addition, messages were examined for evidence of support and it was concluded that messages met basic criteria for supportive interactions (personal perception of support, existence of a social network, and a stressful event that prompts people to seek support). They conclude that CMC “is available for women who desire to regain control over their midlife change� (406).

This study is among a range of studies that examine the effect of the internet’s perceived lack of social cues (Lea, 1992; Rice, 1987; Walther, 1992). The study also examines the internet’s potential in reaching previously unattainable populations (Gurak, 2001; Licklider, 1968; Wright, 2005, Van Gelder, 1990) and/or addressing difficult topics (Van Gelder, 1990; Pew, 2001). The authors conclude that the internet as a medium opens up communication in an area that was mainly treated with silence. Despite the internet’s lack of social cues, as compared with FTF communication, members of this group perceived social support and a sense of community. Some of the relationships even extended to FTF. One limitation of this study is generalizability; how might these findings be translating to other settings and topics?