The doctor is IN–and on line


hicago dermatologist Candace Thrash isn’t a techie, but she does have her own interactive Web site for patients, something just half the nation’s physicians can say.

On it, you can schedule or cancel an appointment, refill a prescription and print those tedious patient-history forms, which can be filled out at your leisure in Starbucks. You also can buy eye cream at 4 a.m. and scan a short bio on Thrash, who recently had her second child. If you’re scheduled for surgery, you can read pre- and post-operative instructions at your convenience.

“I had no idea how much labor was involved in getting one of these off the ground,â€? Thrash confessed in an e-mail to friends and relatives when announcing the debut of the site,

“I feel like I have given birth all over again!”

In a way, Thrash has; she considers her Web site a living entity that requires constant care and attention. It’s a reflection of her practice, she said, and it’s designed for what she thinks today’s patients really want: connectivity and convenience.

Unlike the banking, restaurant and travel industries, the medical profession has been slow to embrace the Internet’s potential customer service benefits.

But despite concerns about patient privacy, costs and time constraints, a growing number of physicians are encouraging patients to go online to do things such as check lab results and immunization records, request refills and appointments, and e-mail their physicians with non-urgent medical questions.

At Chicago’s Water Tower Dental Care, patients can receive a modern version of the dental postcard: an e-mail or text message that reminds them of Wednesday’s 2 p.m. appointment.

Meanwhile, some of the more innovative doctors are blogging, creating educational podcasts and videos, holding virtual plastic surgery consultations and using Garageband to record patient-education sound files.

On the extreme end of the spectrum, doctors such as Jay Parkinson of New York have eliminated their offices. Parkinson, who bills himself as a “new kind of physician,” only makes house calls and is accessible 24/7 via phone, e-mail, instant message, text messaging or video chat.

“Patients want to know how their doctor thinks,â€? said Westby Fisher, director of cardiac electrophysiology at Evanston Northwestern Healthcare. Fisher sees his blog, Dr. Wes as both a creative outlet and a way to connect with patients.

“Does he think outside the box? Embrace technology or avoid it? Can he stand up against respectful criticism? There are a lot of issues that go beyond what we could ever find in a quality survey.”

While Fisher admits it can be scary to expose your thoughts to the public, “it’s this type of transparency that improves a patient’s understanding of what matters to their doctor, the limitations inherent to the medical profession, and it lets them see their doctor’s more human side,â€? he said.

Although most doctors are wired for things such as e-mail and professional research, most physician offices are still not automated, said industry analyst Elizabeth Boehm of Forrester Research in Cambridge, Mass. Small practices lack the staff and resources to install electronic medical-record systems, and many doctors don’t have time to learn the new technologies.

Others, perhaps envisioning hackers and e-mails with subject lines that read “YOUR HIV TEST IS POSITIVE,” argue that privacy issues get in the way. And some worry that the technology will replace good old-fashioned face-to-face communication.

But today’s patients, who resent waiting hours for appointments, say they never get much face time with their double-booking doctors anyway. And thanks to electronic Medicaid reimbursement, a stronger federal push for a national health-information infrastructure, and health plans that will pay doctors to hook in to members online, physicians are increasingly meeting their customers where they already are: online.

Eighty percent of U.S. adults are online, and nearly three-quarters have used the Internet to research health information, according to a Harris Interactive poll; those numbers are expected to grow.

Next year Google plans to launch an online health service that will include personal medical records, health-care-related search features, diet and exercise regimens, and a directory of physicians with links to Web sites.

“Fifty percent of people say their physicians don’t have Web sites; 80 percent wish they did,â€? said John Ryan, founder and head of the International Association of Dental and Medical Doctors, which is working to breathe new life into the health-care world. Part of that mission includes curing the medical profession’s Internet deficiency; doctors who join the group can get a Web site at a discount.

“Treating patients has always been the focus,” Ryan said. “But gradually we doctors have realized that to effectively treat patients and offer the best service, a Web site is vital. It’s not that they’re afraid; it’s that they’re so busy they don’t want to take time to play with it. Also, most sites are fairly expensive.”

But the lack of attention to customer service is exactly what’s dogging so many of the practices and making it hard to make money, said Mark DiMassimo of DIGO Health Brands, a health-care marketing company working to persuade doctors to purchase Web sites with the domain name ‘.md’ (pronounced “dot MD”). Currently, more than 6,000 doctors, practices, hospitals and health-care marketers own .md domains.

“The question patients used to ask is, ‘Why do I have to wait two hours in the waiting room?’â€? DiMassimo said. “Now it’s, ‘Everyone else communicates with me by e-mail. Everyone else has a Web site that orients me. Why can’t I walk in the door knowing the answers?'”

A doctor’s Web site primarily has two main functions: to help people find physicians or give them more information about their current doctor. After Lisa Menniger’s son recently was treated by an ophthalmologist in the emergency room for an eye issue, she went home and Googled him.

“He was very good, but I wanted to see what his experience and training were,â€? said Menniger, of La Grange. “It was helpful info.”

But as Baby Boomers age, patients will want even more services, said industry analyst Boehm.

“Health-care delivery will have to evolve to encompass new methods of doctor-patient interaction,â€? she said.

One method, Medem’s iHealth system, which provides Web sites, electronic personal records and online communication services for doctors and health-care providers, has 70,000 doctors with Web sites, a 15 percent annual growth since 2000. In addition to e-mail and online consultation—two services that also are growing—Medem doctors can embed You Tube-hosted video on their Web sites to educate, explain treatment plans or procedures and introduce their practices to patients.

Video is a huge advantage from a marketing standpoint, “because no matter how bad you are on camera, it’ll be better than a standard photo, and half the docs don’t even have that,� said Ed Fotsch, CEO of Medem, which was started by the American Medical Association and several national medical-specialty societies.

“But it’s less about [marketing] and more about being able to communicate with patients online. That’s where the value is. And the demand.â€?

The benefits aren’t limited to the patients, however. Some digital doctors report increased efficiency and revenue; it also can free up staff from phone calls to give more personalized attention to patients standing in front of them.

For Thrash, who is on staff at Swedish Covenant Hospital, the Web site allows her to stay plugged in to her job while at home on maternity leave. It also means she can spend less time opining on what many of her clients really want to know about: skin-care products and cosmetic procedures.

“I love that part of my job, but I think it discredits me if the patients feel like they are being sold,” she said. “With the online store, I can arm them with information and perhaps a sample or brochure. If they decide they want the product, they can go online and order it. If they don’t, they don’t. No pressure.â€?

Thrash also knows the technology has its shortcomings. Though patient-physician messaging is a national trend—doctors are starting to charge a fee similar to a co-payment for it—Thrash will e-mail (at no charge) only if it’s a patient’s preference, and even then, it’s an exception.

“I’m afraid patients will start sending me long messages describing their symptoms as a substitute for a face-to-face medical visits,â€? she said.
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