E-mail Access and Improved Communication Between Patient and Surgeon, Archives of General Surgery

This is really a post about three items, a study, a critique, and a blog response, which addresses the issue of patient-physian e-mail exchange with data, attitudes, and approach to behavior change.

  1. Peter Stalberg et al., “E-mail Access and Improved Communication Between Patient and Surgeon,” Arch Surg 143, no. 2 (February 1, 2008): 164-168.
  2. David S. Mulder, “E-mail Access and Improved Communication Between Patient and Surgeon–Invited Critique,” Arch Surg 143, no. 2 (February 1, 2008): 168-169.
  3. “The Doctor Is Online – Well – Tara Parker-Pope – Health – New York Times Blog,”.

The first item is a prospective study performed by endocrine surgeons in Australia who asked, “What would happen if we encouraged patients to contact us via e-mail about their upcoming endocrine surgery?” They randomized a group of 100 patients, half of whom were explicitly told to access their surgeon via e-mail and half who were not told this, but given the information in associated materials.

It is great to see a study like this performed in a surgical population, and confirm many of the findings we’ve seen in practice for some time: Physician recommendation makes a significant difference. Information needs of patients are often not met in the face-to-face interaction. Patients’ families and communities have information needs too (9 % of e-mails were sent by family members). That’s the study (Item #1).

The critique attached appears to reluctantly state that this type of communication will “become an important part of any future electronic medical record.” It perpetuates myths about Internet access, such as the percent penetration (it’s actually now 76 % among all Americans over 60 % in households with incomes less than $40,000). Initiatives like this can support better understanding of that issue. The value of our surgical partners having his conversation is great, regardless. That’s the critique (Item #2)

The blog item is a review posted by Tara Parker-Pope, who’s very enthusiastic about the report and the value of the communication. The interesting part (as in many blogs) is in the comments, back and forth. This is where behavior change potentially comes in to play, as people sort out concerns as part of the process (“before you change your behavior, you have to change your mind.”) I notice that Ms. Parker-Pope refutes or adds to some of the comments in a way that is interesting – she puts them in between the person’s note and their signature. Some of the comments are of the ad hominem variety. The discussion seems to get off the track of patient-centered care.

I think this speaks to the emotionally-laden nature of this discussion. As I have often said (see “Pushback,” from the DailyKaizen blog), part of this process is to listen with respect, know “why?” we want something to happen, and allow people to understand what that “why?” is. If we are not sure what it is, then we risk misunderstanding. I think this is the challenge in the way the blog is constructed and the discussion being led. The goal of a LEAN/Toyota inspired approach to improving health care is based on respect for the customer (the patient) and those who care for them. We will definitely get there. That’s the blog post (Item #3).

Item #4 is your comments. Post away!



A favorite topic for all of us. I am struck by the approach that we reasonably take towards winning hearts and minds first, and inviting forays to the future second. Emily Hull, one of our stars came back form a meeting in Denmark with a quote that has really resonated with me – "It is easier to act yourself into new thinking than it is think yourself into new acting" Michael Bergstrom

We obviously need to address the system barriers that currently exist, but enhanced communication with patients is a tide that lifts all boats – we just need to take some small steps to see.


There is no question that email is preferrable to the phone. That's why its used everywhere else. Patient information needs to be encripted, so that we use an on line portal http://www.housedoc.us, which is HIPAA compliant, free, and easy to use. Its been a big help.

Ted Eytan, MD