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Release: Immediate

E-mail service gives UI family physicians alternative for informal consultations

IOWA CITY, Iowa -- Physicians often seek informal advice from specialists about their patients' problems, but many times the consultations require a round or two of phone tag or happen hastily as the two colleagues pass each other in a rush.

Dr. George R. Bergus, a University of Iowa associate professor of family medicine, has alleviated some of these consultation frustrations for doctors in his department. He has taken the interaction to the Internet.

Two and a half years ago, Bergus developed an e-mail consultation service. The system allows UI family physicians and the department's residents to get in touch with various UI specialists via computer. A progress report on the service appears in the November issue of the Journal of Family Practice, due out today.

"As a primary care doctor, I make heavy use of consults," Bergus said. "But, trying to link up with the specialists can be difficult. Two challenges are knowing whom to track down and then trying to track that person down."

The service Bergus developed takes care of those problems.

Here is how it works: a UI family physician with a question about a patient's problem e-mails one of more than 30 participating UI specialists. The consultant responds to the question, which the service then posts for all members to see. While many doctors use e-mail to contact colleagues for advice and to participate in discussion groups, Bergus said he could not find evidence of any other existing formalized e-mail consultation service.

According to Bergus' published report, of the eight UI family physicians who used the service, all reported that the e-mail consults were helpful. The service also was available to residents in the department, as well as those practicing in a few outlying UI clinics.

Bergus warned against relying just on the e-mail option, though. The average response time was 16.1 hours.

"This isn't meant for every type of question," he said. "Sometimes you need the answer now."

While e-mail consults are not appropriate for all situations, they are convenient for many non-emergency problems. The physicians can save the question and answer in written form, allowing doctors to retrieve the answer in the future without having to re-ask the question. E-mail also allows doctors time to reflect on their inquiries or replies. Because all participants see the questions and answers, the information can be an educational aid for everyone.

"The answers not only benefit the patients, they provide learning opportunities for the primary care physicians," Bergus said.

During the first 18 months of the service, members sent 241 e-mail consult requests. Of those, only four went unanswered. Adult medicine questions accounted for 53.1 percent of the inquiries, followed by obstetrics and gynecology with 25.3 percent, surgery with 12.7 percent, pediatrics with 5.1 percent and other categories making up 3.8 percent of the inquiries. Questions about management were most frequent, accounting for 51 percent of the inquiries. The questions were divided almost equally between faculty and resident family physicians.

Some 23 of the 26 consultants at the time Bergus polled them reported they were able to easily integrate the e-mail consult service into their daily schedules, but eight reported that the service had increased their workload. Some 20 consultants indicated they enjoyed participating in the project, and 17 believed the service enhanced their teaching role. The consultants did show concern for the lack of follow-up information about their advice. Only two reported that they had ever received feedback. Some 22 specialists indicated they would have appreciated the follow-up information.