CONTACT: BECKY SOGLIN
2130 Medical Laboratories
Iowa City IA 52242
(319) 335-6660; fax (319) 335-9917
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
"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