Electronic Communications with Patients: Improved Safety, Improved Access, or Electronic Leash—Principles and Prospects

Wong and colleagues [1] suggest that Maimonides implies physicians should be available to their patients ‘‘...at all times,’’ via cell phones. That could occasion an editorial of its own about the divine omnipresence called for, the reality that we are not available even to ourselves at all times, and that such dependence seems both impossible and damaging to a patient’s sense of self-efficacy and independence. Their rhetorical device is used to introduce a discussion of cell phones, a recent but certainly not the last medium for doctor–patient communication. The authors touch upon how the core principles of communication are modified by telephonic communication and further so by cell phone use; their comments also pertain to the role of other electronic communications like e-mail, pagers, answering services, intercoms, and devices like electrophysiologic monitors. We propose here to add to the white noise a miasmic semblance of shape that derives from the robust literature about communication in general [2] and telephonic communication in particular [3]. When we are in an age in which many can be reached at most times, when pictures soon will be routinely added to sound, when physiological data will soon be flowing faster than drone videos from Pakistan, we need to think about how to digest all this electronic chyme. Interactive Web sites, electronic social networking, and texting have so altered the way electronically savvy individuals interact that the cell phone call may soon seem as dated as pagers. However, because doctor–patient communication lags in its adoption of new technologies—many doctors do not feel confident assessing patient needs over the phone—we will briefly review the literature on communication skills and its application to telephonic interactions. Much writing about any sort of communications takes the form and stance of the present article: anecdotal, thoughtful but not theoretical, and free of robust scientific evidence about what actually happens, what its effects are, and how it matters to care in an empirical sense. We actually know much worth mastering about doctor–patient communication. There is an emerging consensus model based on over 10,000 articles [4], most relevant to electronic communications and cell phone use, albeit by extrapolation. In brief, whether face-to-face, on the colonoscopy table (before the injection), or on the phone, communications are about gathering information, communicating information, or developing or maintaining a relationship, which includes managing patients’ feelings of dependence, independence (sometimes called activation), a sense of safety, and a sense of autonomy. Skilled A. B. Reisman Department of Medicine, Yale University School of Medicine, New Haven, CT, USA e-mail: Anna.reisman@va.gov