A new survey shows that fewer than one in 10 GPs (10%) in England and Scotland use e-mail consultations with patients while more than half (50%) have no plans to introduce them. Researchers asked general physicians and practice managers at 421 practices around areas of Bristol, Oxford in England and in Lothian, the Highlands, and the Western Isles in Scotland due to their diversity in culture and the financial statuses of residents.

The results showed that only about 6% of practitioners were implementing e-mail consultations with patients.  The reason for this imbalance was the fact that consultants felt it would create a greater workload and increase the possibility of communication breakdowns.

Survey results, published in British Medical Journal (BMJ) on July 4, highlighted responses from 319 practices (76% of those contacted) which showed only 6% (18/318) of GPs were implementing e-mail consultations with patients, although two-thirds (211; 66%) regularly conducted consultations via telephone. Just over half (169/318) of practitioners said  they had no plans to introduce e-mail consultations at all while 20% said they intended to adopt e-mail consultations into their daily routines.

Practitioners said it may be difficult to manage the exigencies for e-mail and video consultation since it would greatly increase their workload. They also had reservations due to security and privacy concerns with this type of consultation. However, a few reported having found benefits, such as patients being able to send photographs of transient rashes or an audio file of a child’s cough.

Optional-free text responses from 28% of practices said that their reasons for not using e-mail consultations included concerns about workload, confidentiality, and possible legal medical consequences. None of the practitioners surveyed were using consultations carried out via web streaming videos with the vast majority (273/318; 86%) not planning to introduce them at all.

The study authors, led by Dr. Heather Brant, Senior Research Associate at the University of Bristol said, “Despite policy pressure to introduce consultations by e-mail and internet video, there is a general reluctance among GPs to implement alternatives to face to face consultations. The survey and free text responses underline that both the reluctance and enthusiasm for these alternatives are mainly speculative and reflect the fears of the profession around their burgeoning workload.”

Telemedicine has a risk of communication breakdown. Due to bad weather, servers crashing, “lines” being busy, or a million other reasons, the patient would not be able to be connected to a doctor. This problem is significantly more alarming when there is a medical emergency. Also, a doctor has to be available 24/7, 365 days a week for the same reason, otherwise the treatment is pointless. Furthermore, there will be a need for security since all forms of information can be hacked. Hence patients who are mindful about their privacy will be turned off by the idea that someone might be “listening in” to their conversation.

The survey is part of the Alt-Con project funded by the National Institute for Health Research’s Health Services and Delivery Research program looking at alternatives to face-to-face consultations in general practice, and the impact on different patient groups.

Another 2013 study looked at experience of using e-mail consultations for general practices. According to the study reports, approximately 21-23% of GPs in the UK have consulted with patients using e-mail, but little is known about the nature of this use and what it means for clinicians and patients in general practice.

In total 10 GPs, 14 patients, and six experts were interviewed. Consultation by e-mail was often triggered by logistic or practical issues; the benefit for continued use was convenience, for GPs and patients.

The results showed that consultations in general practice occur unsystematically in a haphazard manner. Both patients and GPs had reservation about the practice, citing security and privacy as the main reasons for not fully adopting the methodology in daily practice.

Future use of this technology in the medical landscape depends upon the introduction of better security, privacy and reliability measures to prevent clinical mishaps, misdiagnoses and clinical errors. Once these measures are introduced, both GPs and patients will be able to reap the benefits.