American College of Physicians Ethical Guidance for Electronic Patient-Physician Communication: Aligning Expectations
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Department of Medicine, University of Chicago, Chicago, IL, USA; 2Center for Ethics and Professionalism, American College of Physicians, Philadelphia, PA, USA.
Communication is critical to strong patient-physician relationships and high-quality health care. In recent years, advances in health information technology have altered how patients and doctors interact and communicate. Increasingly, e-communication outside of in-person clinical encounters occurs in many ways, including through email, patient-portals, texting, and messaging applications. This American College of Physicians (ACP) position paper provides ethics and professionalism guidance for these forms of e-communication to help maintain trust in patient-physician relationships and the profession and alignment between patient and physician expectations. KEY WORDS: electronic health records; patient-physician relationship; patient-doctor communication; electronic communication; medical education; ethics; professionalism. J Gen Intern Med DOI: 10.1007/s11606-020-05884-1 © Society of General Internal Medicine 2020
INTRODUCTION
How patients and doctors interact has changed as electronic communication (e-communication) has become commonplace.1, 2 While e-communication has many benefits, including supporting the patient-physician relationship and increasing accessibility to enhance patient care,3 it must be used thoughtfully and effectively to ensure ethical and professionalism standards and trust in physicians and the profession are maintained. This position paper from the American College of Physicians (ACP) offers recommendations for navigating e-communication, focusing on ethics and professionalism in patient care; privacy and confidentiality; practice considerations; and alignment of patient and physician expectations. It examines e-mail, patient-portals, texting, and messaging applications between patient and physician—not telemedicine, telephone, video (i.e., synchronous) or other applications, or communication between clinicians. Patient-physician e-communication can take many forms, with e-mail and patient-portal communication most common; less data Received July 10, 2019 Accepted April 28, 2020
exists about text and messaging application utilization.2, 4–7 Between 16-72% of physicians report e-mail communication with patients5, 6 with higher utilization in academic centers, larger practices, and primary care.4 With the rapid expansion of electronic health records (EHRs), patient-portals to enhance patient selfmanagement and communication are increasingly being adopted.4, 8 As of 2015, approximately two-thirds of office-based physicians reported using EHRs with patient-portal capabilities, a more than 50% increase since 2013,1 but substantial variability in physician portal usage by specialty remains.9 As e-communication becomes more commonplace, attention should be paid to potential gaps in communication, patient safety issues, confidentiality, and disparities arising from barriers to technology use.7, 10 Published guidelines on patient-clinician e
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