You’ve had a physician Web page created for you through NEUROSURGERY://ON-CALL® (N://OC) or Medem; you’ve even developed a Web site for your practice. Patients are sending you e-mails and some want to come for treatment. What’s the next step in expanding your practice through the Internet? Are you prepared for 30 or more e-mails per day? What’s your policy for answering these inquiries? How do you avoid practicing medicine in another state without a license? These are some of the issues you will face if you expand your practice through the Internet.
Be Specific
Your first step in using the Internet should be to put on your site clinical information on your subspecialty area or a specific disorder you treat. It’s not realistic to promote your entire range of expertise. This information may be in the form of a clinical topic review, cases or even a grand rounds presentation. The subspecialty pages or site should be linked to other medical sites on the Web, including N://OC ® and general medical index sites. An e-mail to the administrator is often all that is needed to have your site linked. More importantly, ask patient information and support sites to link to your material.
Prepare to Answer E-Mail
A well-linked Web site may generate more than 1,000 e-mails monthly. Try to answer them within 48 hours during the week. Also be sure to adhere to the new federal rules on the privacy and security of healthcare information. See Privacy Rules to be Costly
You obviously will not be able to answer all these e-mails on your own. At our program, two nurses in collaborative practice, one on the adult service and one on the pediatric service, answer the majority of questions.
Many of the e-mails will pertain to a medical condition. These can be answered directly or the patient can be pointed to the Health Resources section of N://OC ® or other sites. Patients seeking a neurosurgeon can be referred to a local neurosurgeon or to “Find a Neurosurgeon” at N://OC ®.
Some patients seek medical advice. Be careful not to provide a medical opinion online. It is still uncertain whether you are practicing medicine in your own state or in the state in which the inquirer resides. Some of these patients can be referred to clinical services in their own state or given general information about the condition.
Patients, of course, can send you records and radiographs. Once reviewed, a nurse can tell them whether a trip to your practice for an opinion would be worthwhile.
Some Internet patients will want to come to you for surgery. Additional tests that may be needed prior to surgery can often be arranged in or near the patient’s own community. For studies that are specific to your institution, the test can be arranged a day or two in advance to reduce the number of visits the patient will make.
In our practice, patients make a minimum of three trips: the initial evaluation in the clinic, the surgical admission and at least one postoperative follow-up.
A Different Kind of Bond
On first appearance it may seem that the follow-up of patients referred through the Internet will be less than normal. Actually, it may be the opposite. Your nurse will likely be in contact with the patient through e-mail and or by phone on a weekly or perhaps a daily basis. Patients referred through the Internet feel a different bond with you and your team. Once you have responded to them by e-mail, they know that this channel is open and will use it. You must be prepared to respond to this need and welcome it since it helps ensure good post-operative care.
Many patients contacting you through the Internet will never come to you for treatment. However, your response to their inquiries brings a new level of community service by our profession. Many of those who do visit for evaluation and possible treatment will become the greatest advocates for yoour practice. It is not uncommon for the results of a consultation with you to appear in an Internet chat room by that afternoon. Treat the patient well: bad news travels even faster than good. With planning, expanding your practice on the Net can be rewarding for both the patient and the physician.
Send your comments and suggestions to John Oro’, MD, at [email protected].
Dr. Oro’ is Professor of Neurosurgery at the University of Missouri. He serves as director-at-large to the AANS Board of Directors.