The doctor won’t see you now. He’ll e-mail you.

December 4, 2012

There's not much to enjoy about sitting in a doctor's waiting room, leafing through old magazines and waiting for an eventual appointment. New research suggests there might be a new way to eliminate that experience entirely: Move doctors' visits online. 

University of Pittsburgh's Ateev Mehrotra lead a team of researchers in comparing electronic and in-person visits to the doctor at four primary care clinics in Pittsburgh. They looked at two relatively simple conditions: sinus and urinary tract infections, where doctors either worked with patients face-to-face or via e-mail, with the patient filling out a series of questions about his or her condition and the doctor making a prognosis.

Their results, published this month in the Journal of the American Medical Association, suggest that the outcomes are relatively similar. Here's what that looks like in chart form:

There were certainly more visits in person than those conducted electronically. When you dig into the percentages, they tended to have similar outcomes. Five percent of those who presented with a sinus infection came back for follow-up within three weeks in both groups. For urinary tract infections, that number stood at 7 percent. Mehrotra and his colleagues use this as a proxy for understanding cases where the medical issue wasn't fully solved and more treatment was required.

There were, however, some disparities: For those with urinary tract infections, patients seen in person were much more likely to have a follow-up scan ordered versus those seen in person. Those seen electronically were much more likely to have an antibiotic ordered.

"When physicians cannot directly examine the patient, physicians may use a 'conservative' approach and order antibiotics," the researchers write. They add that, overall the high rate of antibiotic prescriptions "for both e-visits and office visits is also a concern given the unclear benefit of antibiotic therapy for sinusitis."

It's also worth noting that separate research has found that patients who e-mail with their doctors tend to have even more in person visits, potentially hampering some expected productivity gains.

This is a small study: It looks at four clinics in one city. It doesn't mean that electronic doctor visits are the next big thing, but does seem to suggest they could be one part of our future health care system.

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Neil Irwin · December 4, 2012