NEW YORK -- Imagine having 24-hour access to your doctor to request a prescription refill, make an appointment or ask about the pain in your neck.
Kirstin Frosh has such a relationship with her son's pediatrician -- over the Internet. She communicates with Dr. Keith Gladstien routinely over his Web site to ask for medical advice.
Last month, an e-mail helped Frosh secure an early morning appointment with Gladstien after 2-year-old Alexander was bitten by a spider at their Orange, Calif., home.
''It's fabulous,'' she said about using e-mail. ''A lot easier than using the phone.''
Across the country, a growing number of doctors are going online to communicate with patients, a move they hope will make their practices run more smoothly and increase their responsiveness to non-urgent matters. With most homes now having access to the Internet and most physicians already using the computer network for administrative matters and research, it's only natural that patients and doctors have begun meeting in cyberspace.
E-mail can help doctors who want to teach patients more about diseases or conditions but don't have time in the office. It also can help patients get answers to questions they either forget to ask or are too embarrassed about when seeing the doctor.
But the trend, only in its embryonic stage, has many detractors, and even some supporters stress that e-mail is best suited for handling physicians' office administrative chores rather than replacing in-person or telephone chats between patient and doctor. It is not the place to turn in a potential emergency.
''To the extent that the electronic medium can fit in doctors' work flow and be sensitive to the needs of patients, I think e-mail can be a home run,'' said Dr. David Stern, an internist at the Ann Arbor, Mich. Veterans Affairs Hospital. Stern is helping to lead a three-year study on doctor-patient e-mail being conducted at the University of Michigan and paid for by computer chip maker Intel.
The first results of the study, released last year, found 40 percent of the 320 patients surveyed regularly use e-mail, but only 14 percent use it to communicate with their doctors. About 70 percent of the patients said they want e-mail access to their doctors, the survey found.
The study also polled 75 doctors, and found 83 percent believe e-mail is a good way to answer patients' non-urgent medical questions. But only 27 percent said they offered the service.
To help spur the trend, dozens of companies have sprung up in the past two years to facilitate the doctor-patient online communication. They all promise secure lines that ensure privacy-- something not guaranteed by regular e-mail accounts. And they say such systems will save doctors time because their e-mail systems will link into the patients' records.
But some doctors remain skeptical. Some believe that encouraging patients to contact them via e-mail will lead to an unmanageable deluge of requests. Others cite privacy considerations, worrying that hackers might be able to read e-mails that are supposed to be confidential. Still others feel that e-mail is not personal enough.
''Doctors are primarily interested in taking care of human beings and communication is of secondary interest,'' said Michael Barrett, a senior analyst with Internet research firm Forrester Research. ''The trouble with doctor-patient e-mail is the more it succeeds, the more it is destined to fail,'' he said referring to the potential for e-mail to inundate physicians.
Dr. Darrick E. Antell, a New York City plastic surgeon, has heard the complaints, but says he hasn't had problems since he starting e-mailing with patients about five years ago.
''The advantage of e-mail is that patients can go back to refer to it again and again,'' he said.
''Confidentiality issues have been raised but people can tap phones too and it (e-mail) is probably more secure than a paper chart that anyone can read,'' Antell said.
In recent weeks, Antell has received e-mail from patients praising their surgery results, inquiring about the cost of a tummy tuck and looking for more information about eyelid surgery.
''I believe this is a resource that all doctors will eventually embrace as just another type of communication,'' Antell said.
Gladstien, the Anaheim Hills, Calif., pediatrician, said he prefers e-mail to phone calls. ''That way I can respond when it's convenient to me and patients can receive the information when its convenient to them.''
Gladstien said he is careful not to try to diagnose anyone's condition over e-mail, but rather to answer general health questions and help determine if a patient needs to be seen in the office. By being able to respond by e-mail, especially over the weekend, he sometimes can save parents unnecessary trips to the emergency room.
How well e-mail helps patients depends on the doctors and patients using it, said Charles Inlander, president of the People's Medical Society, a consumer health group, based in Allentown, Pa. ''It's only as good as the ability and willingness of the doctor to answer in a timely fashion,'' he said.
One drawback of e-mail is that it's a one-sided conversation, Inlander said. The queries and answers may just lead to more e-mail, instead of resolving the original issue.
But Dr. Mark Ballentyne, a family doctor in Newington, N.H, said e-mail saves him time. ''I can respond to e-mail on my lunch break rather than have to be interrupted from a phone call,'' he said.
Ballentyne's group practice, Martin's Point Health Care, has an Internet system that gives each patient his or her own health Web page. The system sends patients health information specific to their diseases and conditions, and it enables them to schedule appointments and query their doctor online.
The practice has a nurse prioritize the e-mail queries much the way they do telephone calls.
Doctors are cautious when discussing sensitive matters over the Internet, Ballentyne said. For example, e-mail is not the place to give out results of AIDS or cancer tests. Instead, the e-mail is best for more routine matters such patients keeping their doctor updated about their blood pressure or blood sugar levels, he said.
''The best thing about e-mail is no one has to sit by the phone waiting for the doctor to call back,'' Ballentyne said.
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