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How i...

Do email surgeries

Dr Lisa Silver and her partners communicate with patients by email, which she says works well for minor problems and administrative matters

Whenever I mention that we offer patients direct email access to everyone in our practice including the GPs, there is a stunned silence, followed by a grimace and then a bombardment of questions such as 'Don't patients abuse it?' and 'Don't you get forwarded loads of junk?'.

For the GPs, the nurses, the practice manager and all the non-clinical staff, email access has been a great success and the patients absolutely love it. We should be embracing technology, it genuinely saves time. After all, everyone routinely uses faxes to convey information. We started about four years ago by offering email access selectively to a few patients who might wish to begin ordering their repeat prescriptions by email. The surprise to us was that it was taken up mainly by the over-65 'silver surfers'. We then extended access through our website to include all of the practice. I have yet to be forwarded any junk mail by patients and they genuinely respect it as a mechanism for contacting their GP – usually about administrative problems or conditions that are not serious but would otherwise take up an appointment.Email consultations invariably strike fear into the hearts of most of my colleagues an-xious that patients may email when they are suffering something that should be seen immediately and then sitting waiting for the GP to reply. But patients are not stupid. Most are pretty sensible and do their own rule-of-thumb quality control before emailing. Ordinary non-medical folk can usually work out the best solution to this dilemma. Email works incredibly well as a replacement to the telephone call follow-up. I find this useful as patients often email to say the problem has resolved and I can then file their email in their notes. If the problem remains and perhaps needs a referral I can let the patient know what actions I am taking.Patients send us digital photos of skin lesions and we also take digital photos of these lesions in surgery as a record. Don't forget we can always tell the patient to come to the surgery to see us if we are not happy with the way an email consultation is going. I cannot think of a single profession that does not routinely give out its email addresses and I frankly cannot think why we should not do so as well. We are businesses, and our patients are our livelihood – other businesses would not survive nowadays without email.However, there have to be some caveats – after all we are dealing with what can be sensitive medical conditions. You must keep contemporaneous notes and you absolutely must copy and paste your email and its reply into the notes. You need to be certain that the person emailing you is the person they purport to be – not easy if you have a rapidly changing list. But if you are uncertain then all you need to do is tell the patient to make an appointment.The risk is clearly small that someone is going to hack into a computer and emailing me fishing for information, but I believe I would be astute enough to recognise this if it ever did happen.

Protect yourselves

The lawyers will tell you that if patients are contacting you via the internet as opposed to a more secure intranet, then protect yourselves by stating in your practice leaflet and post on the website that if patients wish to contact you by email they must be aware that the internet is not secure

I also like email because it has a tinge of green about it. I reckon to do about five emails a day to patients, and if this saves five patients getting in their cars to come to the surgery I think this is worthwhile. I can send electronic leaflets to patients and can direct them to well researched sites rather than them trawling the net.So where is it going? Politicians and newspapers have been giving GPs a hard time over access of late and, although we have not taken this step yet, I can see a time in the future when we may be offering instant messaging slots for patients or even instant messaging evening surgeries for people who are at work and cannot get to the surgery.Email consultations cannot take the place of a face-to-face consultation but they can help deal with some of the minor problems and administrative tasks that patients consult us with.

Dr Lisa Silver is a GP in Oxfordshire and a member of the SearchMedica superuser group

Medicolegal advice

Email consultations: advice from the MDU• You must take reasonable steps to ensure information is transmitted securely. If an unauthorised disclosure occurs, you will need to be able to justify the steps you have taken to prevent breaches in patient confidentiality.• Inform patients that no email exchange can ever be 100 per cent secure and ensure the patient is happy to proceed on that basis.• Inform patients in advance that, since email consultations allow no opportunity for a physical examination, there will be circumstances in which it may still be clinically necessary to attend surgery.• Keep a record of email consultations in the notes.• Always consider whether another type of consultation would be more appropriate.• Images of patients are part of the medical record and are subject to the Data Protection Act 1998 and must be protected against improper disclosure.• Consider the quality of the image and whether it can be used to make a diagnosis or assessment or if a face-to-face consultation is necessary.• Check with your medical defence organisation if you have specific queries.Dr Nicholas Norwell, Medical Defence Union medicolegal adviser

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