The doctor is alway in

4/11/2011

DETROIT — Almost a year ago, Kristen Cullen’s husband broke out in hives from head to toe. She suspected he was having an adverse reaction to medication. But she wasn’t sure what to do.

It was late on a Sunday evening. Not typical doctor hours.

But Ms. Cullen didn’t panic.

She turned to one of the trusted tools she has come to rely on since Niall Cullen was diagnosed with colon cancer: her cell phone. She called his oncologist, Dr. Philip A. Philip of the Barbara Ann Karmanos Cancer Institute.

Dr. Philip immediately arranged for Niall Cullen to be admitted to the Karmanos wing at Harper Hospital in Detroit. Once there, the attending physician used his cell phone to e-mail a photo of Mr. Niall to Dr. Philip and other physicians handling his case.

Increasingly, caregivers such as Ms. Cullen and patients are texting, e-mailing, even using Skype to reach health care providers. Many doctors and patients find that newer technologies help strengthen their communication.

“Certainly the explosion in the use of smart phones will mean more and more patients will be communicating with their health care providers using either e-mail or text messaging,” Dr. Philip says. “I feel that with improved communication options for patients and families, better care can be provided, and patient or family concerns addressed in a more timely fashion or in real time.”

In Niall Cullen’s case, doctors quickly developed a treatment plan that eliminated the hives and got him back to work as a software salesman within a couple of days.

“I fear what could have happened had I not been able to get hold of Dr. Philip,” says Kristen Cullen, 40. “They told me that on a scale of 1 to 10 for adverse reactions; he was at Level 9. It was life-threatening if he hadn’t been seen and treated as quickly as he was.

“My phone is my lifeline to his doctors.”

While many patients find such technology extremely useful, some doctors remain reluctant to use it even though the demand is pushing more and more doctors to communicate electronically.

A national poll of 1,612 parents showed that more than half of them would find electronic communication with their children’s health care providers very helpful, but fewer than 15 percent of those parents actually were able to communicate electronically with their child’s pediatrician or other health care providers.

“The study found a big gap between what parents can currently do and what parents feel would be helpful,” says Dr. Matthew Davis, director of the C.S. Mott Children’s Hospital National Poll on Children’s Health at the University of Michigan. Dr. Davis, a pediatrician, says he is comfortable with electronic communication. “My e-mail address is on my card,” he says. But Dr. Davis said he recognizes that some doctors are concerned about medical liability, privacy, and compensation.

While there are no universal guidelines for electronic communication between physicians and patients, most doctors use it only with patients with whom they already have established a relationship. “We need to see electronic messaging as a replacement for a phone call,” Dr. Davis says, “not as a substitution for a visit.”

Dr. Davis and others expect electronic communication to increase due to demand.

“I think it’s inevitable that physicians will move more toward it, if only because society expects and insists on it as the progressively dominant form of communication today,” Dr. Davis says

In October, Beaumont Hospital in Royal Oak, Mich., began using consultation centers in its cardiovascular center. They are outfitted with a system called WebEx that allows video chats for doctors to communicate with patients and/or caregivers who cannot be present at the facility. An access code and password allows people out of town, or even out of the country, to talk with people in the room.

Dr. Marc Sakwa, chief of cardiovascular surgery, says he has found the system especially helpful for talking with the adult children of elderly patients when those children live out of town.

“Very often, especially in metro Detroit, you have kids who have moved away to New York or California or wherever, and the kids want to know what’s going on. The patient tells their children what’s going on, but a lot of things get lost in the translation,” Dr. Sakwa says. “Now, we can set the room up in advance. Everybody’s together and everybody understands what’s going on. I think it’s the wave of the future.

“I think it makes the patient and the family more comfortable. Say the mother is going to have a surgery. The daughter can’t be there for all the pre-operative consultation. But the mother doesn’t understand all the nuances of what’s going on or she forgets to ask a question that the daughter asked. If we’re all there in the same room, it relieves a lot of stress for everyone.”

Dr. Philip expects e-communication to increase and agrees it’s a good thing. He e-mails patients regularly. He also has put out-of-town relatives on speaker phone during consultations with patients.

“In addition to offering an additional communication option e-mails are easier to handle because unlike a telephone page that needs immediate attention I can reply to the e-mail without having to interrupt something that I am doing,” the doctor says. “I can also reply to e-mail even if I am out of state or the country.”

Dr. Philip says technology also allows some exams to take place without an office visit.

“Patients who start on a new treatment that is expected to cause some major side effects can have their condition monitored in real time using the Internet, including the uploading of digital photographs,” he says.

Dr. Tsveti Markova, a family medicine physician with the Wayne State University Physicians Group, says the health system’s movement toward becoming more patient-centered demands e-communication and in some ways it’s easier for doctors.

“Most of us would rather intervene sooner than later,” Dr. Markova says. “E-mailing and texting is fine as long as the communication is secure.”

Kristen Cullen believes technology saved her husband’s life.

She keeps her phone with her constantly, and sometimes has her laptop at her side.

When there’s a new development, she e-mails his doctors doctor with an update. Doctors usually respond shortly thereafter with a text, e-mail, or phone call.

Niall Cullen used his smartphone only once to communicate with his doctors.

On Father’s Day a couple of years ago, he e-mailed a photo he took of one of his sons at Little League championship game in Cooperstown, N.Y.

“Thanks for giving me another Father’s Day,” his message read.