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Release: April 30, 1999

UI study suggests how physicians can respond to unsolicited online 'cries for help'

IOWA CITY, Iowa -- While it's a challenge for physicians to respond to increasing numbers of unsolicited electronic mail messages from people with health care concerns, there is a way to responsibly and practically handle the many requests, according to a University of Iowa study.

Donna M. D'Alessandro, M.D., UI assistant professor of pediatrics and the study's principal investigator, presented the problem and a possible solution of standardized responses at a May 1 presentation at the annual meeting of the Pediatric Academic Societies in San Francisco. The presentation was titled "Addressing the challenge of patient cries for help: an analysis of unsolicited electronic mail messages."

The study examined the more than 300 unsolicited e-mails received from October 1995 to October 1998 by a pediatric radiologist at the UI Hospitals and Clinics. Only about 4 percent of the e-mail inquiries, all sent by people unknown to the physician, fell within the radiologist's area of expertise, while the rest included questions about areas such as allergy, neurology and orthopedics. The most common e-mail query senders were parents or family members of people with health care needs (43.2 percent), patients (13 percent) or friends (9.8 percent). Nearly one-quarter of the inquiries came from people outside the United States.

"While there are e-mail standards set by the American Medical Informatics Association for physicians to use when communicating with their own patients, guidelines do not exist for unsolicited inquiries from people who are not a doctor's patients," D'Alessandro said.

"Many people are seeking medical help on the Internet, but they often can't determine whom to contact for advice and assume doctors have expertise in areas they don't. People send physicians unsolicited, detailed e-mail messages that look almost like medical records, which require a specialist's response. Many of the messages also have an emotional overlay because the people have seen many physicians and are looking for additional opinions."

The UI study also looked at how researchers could respond to the electronic queries.

"Some doctors simply ignore these unsolicited messages," D'Alessandro said, "but we felt physicians have an obligation to answer these calls for help in some form. Because there are ethical and legal limitations as well as time constraints, we can't personally answer all these messages."

The researchers developed a standardized response that directs a person to quality information resources on the Internet and in communities such as primary care providers, local or regional children's hospitals, regional medical libraries and public access PUBMED, a National Library of Medicine online listing of medical resources.

"That way people can learn what's available locally and nationally," D'Alessandro said. She added that regional medical libraries have a mandate to assist the public.

D'Alessandro said the UI study adds to the world-wide discussion on how physicians should deal with unsolicited e-mail inquiries from laypeople.

"We wanted to raise awareness of the problem and get people to consider ways, such as our standardized response, to solve the problem until national standards are developed," she said. The researchers are trying to share the current standardized response with colleagues in the UI College of Medicine and nationwide.

"As patients become more educated health care consumers, we want to help them develop better ways for them to come to physicians with good questions. I think that the electronic interaction can be an improvement for health care overall," D'Alessandro said.

Other researchers involved in the study were Michael P. D'Alessandro, M.D., assistant professor of radiology, and Stephana I. Colbert, formerly the UI senior counsel to the vice president for research. The D'Alessandros have conducted a number of studies involving medical uses of the Internet.

The Pediatric Academic Societies is sponsored by the American Pediatric Society, the Society for Pediatric Research and the Ambulatory Pediatric Association.