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June 25, 2015

Disconnect Between Doctors and Patients on Use of Email and Facebook

Despite guidelines discouraging physicians from emailing with patients, one-third of patients reported doing so anyway

A large number of patients use online communication tools such as email and Facebook to engage with their physicians, despite recommendations from some hospitals and professional organizations that clinicians limit email contact with patients and avoid “friending” patients on social media, new research suggests.

The findings from Johns Hopkins Bloomberg School of Public Health researchers suggest a disconnect between what patients expect and what physicians – concerned about confidentiality and being overwhelmed in off-hours – are willing to do when it comes to online dialogue.

The study is published online June 24 in the Journal of General Internal Medicine.

“The medical establishment needs to figure out how best to incorporate this reality into their practice while properly ensuring security safeguards,” says study leader Joy Lee, PhD, MS, a post-doctoral fellow in the Department of Health Policy and Management at the Bloomberg School. “This is an area where there is significant patient interest, but institutions and health care providers haven’t caught up.”

For the study, the researchers used an online survey delivered to a random sample of 2,252 CVS retail pharmacy customers between May and June 2013. Patients were asked about their interest in using these online communication tools – as well as their physician’s website – to fill their prescriptions, track their health progress and access their own health information. Researchers found that 37 percent of patients had used personal email to contact their doctors or hospital within the past six months and 18 percent reported using Facebook for the same purpose.

The findings related to Facebook are particularly interesting, Lee and her co-authors note, because “most institutions actively discourage social media contact with individual patients.” Nevertheless, the researchers predict that the percentage of patients using Facebook as a means of contacting their doctors “might grow as the average age of Facebook users rises and familiarity with Facebook grows.” The team cites earlier studies from 2009, 2011 and 2012 indicating that a significant number of patients are interested in using the social media platform as a means of contacting their health care providers.

In addition to gauging overall interest in these services, the researchers identified several demographic factors related to patients’ use of online communication tools. Patients between the ages of 25 and 44 were most likely to use email or Facebook to contact their doctors, with 49 percent of patients surveyed in that age group indicating that they had used these tools for this purpose within the past six months. By contrast, 34 percent of patients aged 45-64 and 26 percent of patients aged 65 or older reported the same.

Additionally, survey respondents indicated significant desire to use these online communication tools for filling prescriptions: 46 percent of patients reported being interested in doing so via email while an additional 7 percent claimed that they were already doing so.

The new study did not include the opinions of health care providers.

The American College of Physicians and the Federation of State Medical Boards advises that physicians strictly limit how they communicate with patients via email, keep professional and personal online personas separate and not "friend" or contact patients through sites like Facebook and Twitter.

“Patient Use of Email, Facebook, and Physicians’ Websites to Communicate with Physicians: A National Online Survey of Retail Pharmacy Users” was written by Joy Lee, Niteesh K. Choudhry, Albert W. Wu, Olga S. Matlin, Troyen A. Brennan, and William H. Shrank. Collaborators are affiliated with the Brigham & Women’s Hospital, Harvard Medical School, CVS Health and the Johns Hopkins Bloomberg School of Public Health.

The research was supported by an unrestricted research grant from CVS Health to Brigham and Women’s Hospital.

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Media contacts for the Johns Hopkins Bloomberg School of Public Health: Stephanie Desmon at 410-955-7619 or and Susan Murrow at 410-955-7624 and