FORT WORTH, Texas _ Dr. Daniel Suez makes at least a dozen house calls a day, without ever leaving his office.
E-mail makes it possible.
"It's the best way to promote good medicine," the Irving, Texas, allergist said. "It's a wonderful tool."
Many doctors have been reluctant to hang their shingle at a virtual office because of privacy concerns, but more and more are turning to technology to improve the way they practice medicine. At the click of a mouse, they're checking lab results and answering patients' questions about everything from earaches to ingrown toenails. The service, sometimes free, other times costing $25 or more, is generally not covered by insurance companies.
Physicians are, however, quick to warn patients that e-mail was never intended for emergencies or complex health problems.
"You'll never see someone with chest pains e-mailing their doctor," said Dr. Edward Fotsch, chief executive officer for Medem, a San Francisco-based e-health network founded by the American Medical Association and other national medical societies.
An AMA study released last month found that 78 percent of physicians use cyberspace. About 25 percent of physicians send e-mail to and receive e-mail from patients; three of 10 using the Internet have their own Web sites.
"Five years from now, I don't think a physician will be able to run an office without online consulting, anymore than they can run an office now without a fax," Fotsch said. "I think patients are way past ready for it."
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David Muntz, chief information officer for the nonprofit health care system Texas Health Resources, said he believes technology can minimize administrative hassles and free doctors to spend more time with their patients.
Named one of the most wired health care systems by the American Hospital Association, THR uses Web sites and online technology to serve patients through Harris Methodist Hospitals in Tarrant County, Arlington Memorial and Presbyterian Healthcare hospitals in Dallas.
"I have great hope that it will actually promote the patient-physician relationship and give physicians back the time they need," Muntz said.
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By putting a library's worth of educational material on their Web sites, doctors are able to provide accurate information and address common concerns. Time-crunched patients have found that Web sites and e-mail make their lives easier.
From her laptop computer, Michele Hudson of McKinney, Texas, e-mails her doctor whenever she has a health concern. Over the past two years, Hudson estimates she has e-mailed him 50 times. He doesn't charge her for the service.
"As much as I travel and as busy as I am, it's just much easier," said Hudson, 32. "Instead of wading through a bunch of nurses, or waiting until he gets free moment, I'll e-mail him, and he quickly responds to it."
Hudson said she has no qualms about online security, but plenty of other people do.
"One of the big problems is, patients don't want information about their hemorrhoids splashed across the Internet," said Dr. Charles Hendler, a Dallas internist who after 20 years in medicine recently started offering online consultations.
While Internet medicine offers some efficiencies, the impersonal nature troubles him.
"Basically medicine still has a magic element to it," Hendler said. "Sometimes what someone is telling you is a different thing from what you're seeing. The problem is not having the hands-on experience."
Dr. Stephen Buksh, a Bedford, Texas, internist, said he is concerned about what happens to an e-mail once it leaves his computer.
"If I sent a message about lab results, I don't know if the person's computer is password protected," he said, "or if someone is looking over their shoulder and reading a sensitive e-mail that says something about a sexually transmitted disease or AIDS."
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Muntz said that most computer systems are so safe that it's virtually impossible to improperly access information. Software also is being developed to ensure that protection.
"Paper records are probably less safe than electronic records," he said.
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Privacy is such a concern that Congress passed the 1996 Healthcare Insurance Portability and Accountability Act, or HIPAA, to limit the nonconsensual use and release of electronically stored private health information.
The regulations go into effect this fall, and health care organizations are busy buying software to help them comply.
Some health professionals are so unsure about how the federal law will affect medicine that they are steering clear of online services. The University of North Texas Health Science Center in Fort Worth, for example, does not allow its doctors to conduct e-mail consultations.
In contrast, Medem has embraced technology by launching its Online Consultation service, which connects patients with their doctors through secure e-mail.
The service, two years in the making, has developed a structured, encrypted alternative to regular e-mail. Informed consent guidelines also spell out how the patient can use the service, which provides liability protection for the physician.
Using a password, patients e-mail their questions on Medem's secure network. On the other end, only the physician has the password. Questions about prescription refills can be printed out for a nurse to handle.
Still, some doctors remain leery.
"This is all brand new, and in internal medicine it seems like it would be safe," Hendler said. "But it scares me to death, because you don't want to make a mistake."
In gynecology, one specialty in which the service has caught on, many patients would rather send an e-mail than describe their medical condition over the phone.
With so many people working in cubicles, where every phone conversation can be overheard by co-workers, there is an obvious need for the technology, Fotsch said.
Dr. Daniel Moulton, a Dallas pediatrician, said he can see using e-mail to send out birthday cards or appointment reminders. But he questions its use beyond that.
"If we really wanted to be wacky, we could set up a secure gateway to provide parents password access to specific information," he said. "But I'm not sure it would be worth the cost to maintain a service like that."
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Although the AMA study showed 78 percent of physician use the Web, there's still a fear that e-mailing patients will eat up time, with little financial payoff.
"Doctors that have e-mail addresses on their Web sites have been overwhelmed," Buksh said. "They get not only their own patients asking questions, but people who just happen to find their Web site."
Some doctors have addressed this concern by charging for online services that go beyond routine prescription refills.
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ONLINE: For more about the American Medical Association: www.ama-assn.org.
For more about e-mail physician services: www.medem.com or www.dfwdoctors.com.
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