Family physicians and electronic communication

Increasingly, physicians are using electronic communication in their work. According to the 2010 National Physician Survey,¹ 50% of family physicians and 67% of other specialists e-mail their colleagues for clinical purposes. Approximately 15% communicate with their patients for the same reason. The survey also tells us that 50% refer their patients to websites and nearly 20% of clinics have their own websites.² As these data are from 2010, it is very likely that the number of physicians using electronic communication has since increased. In fact, it is unusual for a family physician not to have an e-mail address today. And many use electronic communications in their practice.

Paradoxically, professional organizations and medical insurers regularly warn us of the dangers of electronic communication. The list of recommendations is quite extensive: do not discuss your patients, even using descriptive terms; do not post pictures or videos of your patients; do not offer medical advice; do not send out personal information; do not make “friends” online; do not post compromising pictures; do not post anything you would not want “people” to know about; and, especially, remember that everything you put online can be used by anyone, at any time, and forever!

In fact, so many warnings should discourage us from using electronic communication and social media for either professional or personal use. But the opposite is happening; the use of electronic communication is accelerating.

How can we explain it? It must be because each of us understands that it is no longer possible to work without computers and electronic communication. Some of these warnings might seem somewhat incongruous or even absurd. For example, how could sending a colleague a picture of a patient’s pressure ulcer to ask for his advice bother anyone? Especially if we have the patient’s implied consent. Is this not what we have always done in person or over the phone? Furthermore, other recommendations are impossible for most physicians to apply, eg, adding security features to our e-mail, encrypting messages, or adding electronic signatures. How would we all be able to do that? It does not matter how many security codes and passwords we use—they end up expiring at the wrong time anyway—it seems even moderately skilled hackers can access any electronic content they want. Electronic medical record software companies and Web designers always guarantee that their products are secure and safe. But, if the Central Intelligence Agency could not contain Edward Snowden or Julian Assange, it follows that anyone who wants compromising information can get it.

Family physicians must be cautious when using electronic communication. But how? Actually, it is quite easy. Remember those telephone party lines in small towns? Several people could listen in on our conversations—some were not even embarrassed to do so! Really, e-mail and electronic communication are the modern versions of the old party line, except that you cannot hear the telltale click of those busybodies. Too bad! Every time you send an e-mail to a patient or colleague, or use an electronic platform for the same reason, do not forget that half the global village might be listening in!

Orwell’s vision has come true.

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