We have already become accustomed, and take it for granted, that the Internet has started a new era of human communication, a new era of the acquisition of information. All fields of human activities, thus also the pharmaceutical industry and its clients – doctors and patients, must react to the new situation.

 
Not only in advanced countries, health care becomes a national sport, religion and a subject of political proclamations: “However, how is the patient, one of the Trinity (note: the doctor, the patient and the pharmaceutical company), actually doing in the era of the Internet?”

There is a laconic answer: “It depends on when, where and what the patient is currently dealing with!”

While obtaining information about a “potential” illness, or rather determining the diagnosis, the today’s patient can be certain of finding dozens of websites in the Internet saying, with a face of a poker player, that it seems to be venous insufficiency, migraine or a breast carcinoma. Fortunately, most of the providers of such information complete their remote diagnosis by a recommendation or a direction to see a doctor! Until that moment, the patient was “all alone” to deal with the matter.

Storyflow:  diagnosis, treatment, poor adherence, patient complaining

Cut. The patient leaves the doctor. The diagnosis has been established, the examinations have been conducted and the treatment has been determined. It seems that everything is in perfect order. The Internet has performed well!

However, during the next visit the doctor finds out – the patient complains – that the treatment does not proceed the way it should. Everything indicates that adherence does not work. The doctor is likely to explain the patient again how important it is to observe the prescribed regimen, to initiate the treatment and to take the medicines exactly as prescribed by the doctor.

The doctor is pushed for time since the next client has been already waiting, so he gives the patient a brochure or a leaflet or, even better, refers them to websites where they can find everything about the treatment – why it is actually important to observe compliance.  The patient has not been alone any more; the doctor has advised and instructed them. Is it enough…?

Internet a websites perform well. But, Mary from the neighbourhood said…

The brochure gets lost in the boot since, after all, it is only an article about “the Internet,” and thus only the card with the website link remains in the patient’s purse. The patient visits the website, reads the volume of information about the illness and the treatment and also why it is necessary for them to use up the medicine, stop smoking, take up fast walking, not overeat, sleep with the windows open and wear stretch stockings – unisex. The key information is provided in the form of video interviews, and the website contains also information for family members or persons providing care. All is confirmed by smiles of satisfied testimonials. Has the Internet performed well!?

No. In most cases, patients are disobedient and light-headed creatures loving information: “Mary says that it will do to take them only for 2 months and that the stockings are useless anyway …”

Solution: Doctor´s authority steps in again – sending customized e-mails on treatment to the patient

There is a single and logical solution. The patient – their treatment requires to be directed by someone who has the authority! The doctor. But the doctor does not have enough time. The third of the Trinity enters the game and offers the solution. It offers the doctor the information service for the patients, which will facilitate remote control and direction of the treatment by the doctor.

The service customized to every single patient. On a special website, the doctor will select and tick the pre-arranged information about the treatment and send it from his e-mail to the patient’s e-mail. The information about the treatment is at home earlier than the patient with the medicine. The doctor also ticks for the patient to arrange that every 3 weeks they obtain an e-mail from the doctor informing them about the treatment and motivating them to keep on and to fill out a short questionnaire about the treatment course to be brought with them for the next visit.

Conclusion. The doctor really directs and controls the treatment course at least in terms of the information flow to the patient. The patient must get the impression that the doctor has a private interest in them, and cares for them so they should not fail. They initiated adherence. The Internet performs; it remains to know how and when to use it…

By David Plodek

We asked potential patients questions related to the use of e-mail for their communication with physicians.

The questions asked and the results of the poll responses are the following:

Have you ever used an e-mail for communication with your physician?

Responders (n=251) were internet users, visitors of a healthcare portal www.ordinace.cz, aged 19-69, from both urban and rural areas, 72 % female, 28 % male.

The question here shows how these results would look like once e-mail communication and healthcare professional advice would start being reimbursed by healthcare security insurance, which is not the case yet.

In another poll, following the first set of questions, we have asked our portal visitors, what was their opinion is on the option of communicating with a physician via e-mail. The poll is still ongoing these days; however the first results show that 75 % of patients would very much appreciate such
a possibility however they do not have it (yet). There are more questions on this subject and also on the topic of personal data concerns. We will bring the detailed results on this poll to you next time.

Physicians´use of e-mail with patients

The use of email as a means of communication between patients and physicians will likely increase as the use of the Internet by general public grows continually. Yet, despite the evidence of increased interest among patients, the uptake of e-mail use by physicians for medical care has been slow.

Our next research which is to be conducted in October and November 2009 will focus on physicians´ attitude and behaviour concerning e-mailing with patients, to have relevant data for the European environment. Now, we can see some results from research conducted in 2006 in the USA, which brought the following results (Data from: Brooks RG, Menachemi N, Physicians’ Use of Email With Patients: Factors Influencing Electronic Communication and Adherence to Best Practices, J Med Internet Res, 2006;8(1):e2, http://www.jmir.org/2006/1/e2/): n = 4203, 689 (16,6 %) had personally used email to communicate with patients. Only 120 (2.9%) used email with patients frequently.

We will ask physicians a series of questions regarding the use of e-mail from the office, the time spent responding to e-mail messages from their patients. The expenses associated with e-mail consultation which are not being reimbursed yet, can be regarded as opportunity cost by some physicians. We want to find out if e-mails represent larger work and time investments than more traditional means of communication such as telephone or postal letters taken from the physician’s perspective.

Healthcare system responsiveness to patients’ preferences and needs: We want to be able to e-mail with our physicians.

As the overall European vision and tendency is calling for a high quality healthcare system with a patient being in the centre of interest, it emphasizes the need to be responsive to patient preferences and needs. The use of e-mail between physicians and patients can be definitively recognized as enhancing the communication and we can already see from our second poll preliminary results that it is generally favoured by many patients. There are several other studies of that were conducted among the general public that show an interest in e-mail communication with their physicians (Moyer C, Stern DT, Dobias K, Cox D, Katz SJ. Bridging the electronic divide: patient and provider perspectives on e-mail communication in primary care. Am J Manag Care 2002;8(5):427-433, Moyer CA, Stern DT, Katz SJ, Fendrick A. “We got mail”: electronic communication between physicians and patients. Am J Manag Care 1999;5(12):1569-1571.(.

By Vendula Machackova

Various researches show that majority of patients feel that their physician does not communicate with them the way they would like him to. Pharmaceutical companies keep on educating physicians about new drugs, new ways of treatment etc. and they are crying out for better patient compliance at the same time. Maybe educating physicians in the right way of communicating with patients could be the way forward.

Note: There is a poll embedded within this post, please visit the site to participate in this post's poll.

There are some rules and best practices that should be followed to reach the goals set.

What does the patient expect from the physician?
- promptness to help, sympathy and care
- quick diagnosis and effective follow-up
- professional medical confidentiality
- quick decision making and action
- personal relationship

What does the physician expect from the patient?

- timely notice of symptoms
- the truth
- compliance and cooperation in treatment
- following the therapy instructions

The physician shall lead a friendly and confidential talk with the patient.
The patient shall listen and conform to the physicians.

The most frequent mistakes and barriers in communication

“The self-diagnosed patient who knows the best”

It is definitely very helpful when patients do have a certain level of knowledge about a disease they suffer from. That is the goal of all disease awareness campaigns. However should the patient be too active in his own treatment or even diagnosing himself and should he enter physician’s office with this attitude, the physician’s authority in his eyes is decreased right from the beginning. It is then difficult to convince such a patient that it is the physician, who should say what the health problem is, how to diagnose it and ho to treat it.

“Patients waiting too long and examined too fast”

- Are patients waiting for the appointment with a physician for too long who are then examined in the office very quickly may feel frustrated and may even become suspicious that they are not receiving a sufficient care. The patient can underestimate his own health problem as a result of this lack of information and medical attention and the result can be low cooperation and will to compliance.

“Physician speaking a language that patient does not understand”

- Beware of speaking intelligibly with the patient! If your patient does not understand what you are saying he will never ask for more information. Use language of normal people without a lot of professional vocables. The patient will understand what you are saying and will be prompt to follow your words in treatment. Patients with good understanding are more likely to stick to their treatment.

“Over criticising the patient for a bad-lifestyle and non-compliance”

- Do not excess criticising your patients!
Patients make mistakes in treatment, they do not always live the way, they should in accordance with medical literature. Even though you know they should do more for their health to make the treatment deliver results, you can not be too hard on them and criticise them too much for every single mistake they make. They sometimes do not understand the consequences of their actions whether it’d be low compliance with their treatment or bad lifestyle habits. You can explain and advice but you should avoid criticising or even screaming, shouting or insulting them. Physicians are professionals, who do their best, but can not control people who do not want to cooperate as much as it can be frustrating.

Both, patients and physician are only human beings. Being a physician does not mean you can not find yourself standing on the other side the next minute and becoming a patient, lying in bed and suffering. Keep the principles of humanity and work with emotional intelligence and empathy.