March 2, 2012

Something Old, Something New


Samizdat refers to self-published texts, first described in post-Stalin USSR.  Political activist Vladimir Bukovsky defined the term best as "I myself create it, edit it, censor it, publish it, distribute it, and get imprisoned for it.” Although it was originally used to refer to written text, many versions of samizdat have since been described, including magnitizdat, the re-copying and sharing of self-created live audio tapes as a means of avoiding political censorship and roentgenizdat, underground recordings actually created on phonograph records made from old x-ray film.

It is striking how technology advances in one part of the world; cassette tapes are replaced by compact discs, and x-ray film is replaced by digital technology, but the old  technologic tools of communication are given a new life in another part of the world.

I have been reflecting on this truism in the wake of recent debates on physicians and email communication.  In midst of the rapid development of digital technology and the adaption of social media tools for application in clinical practice, education, and research, many physicians remain reluctant to use the older tool that social media is rapidly replacing, namely email.

Concerns regarding use of email by physicians as an addition to their practice, research, and education reflect three broad fears: privacy, liability, and cost.

Privacy is a solvable issue given the development of patient portals and the availability of encrypted email; more importantly,  security concerns frankly fail what one colleague of mine refers to as the “straight face test” -- can you say with a straight face that a transmitted fax or phone call is inherently more secure than email?

Liability is a concern, particularly with fear regarding a delayed response to emergent email communication.  This concern would also apply to the all too common office answering machine and is addressed in that setting by a standard disclaimer “if your issue is emergent, please call 911.”  In addition to adding a similar disclaimer to email, tort reform would mitigate this issue.

The most common concern focuses on cost as a surrogate for time.  In our current reimbursement model, physicians are compensated by fee for service, and particularly in private practice, are rewarded for seeing as many patients as they can.  The concern that time spent engaging via email would lead to decreased patient volumes may be countered by the increased efficiency, patient satisfaction, compliance and improved quality of care that email communication would confer.  In addition, email would allow for pre- and post-visit education, monitoring, and communication that would maximize the value found in face-time encounters.  In the long-term, transition to an outcomes-based care would mitigate this as well.

We need to adapt our model of care before we find ourselves as recycled eight-track tapes.

Farris Timimi, M.D., is the medical director for the Mayo Clinic Center for Social Media.

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Something Old, Something New
if your issue is emergent, please call 911.

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