Limiting factors on the transformative powers of e-mail in patient-physician relationships: a critical analysis.

In this article I analyze doctor-patient use of e-mail within the context of the evolving doctor-patient relationship and ongoing changes in the U.S. health care system. Evidence from the published literature on doctor-patient relationships and doctor-patient communication, empirical studies of uses of the Internet by doctors and patients, and commentaries about the Internet's role in health care are examined and discussed to reveal common, unsupported assumptions about the likely impact of e-mail on the doctor-patient relationship and also the value structure associated with current e-mail practices between doctors and patients. I argue that existing research does not adequately account for the technical, professional, and economic forces that are shaping doctor-patient use of e-mail. I conclude that physicians' preferences for technical, instrumental exchanges with patients will likely mitigate the positive influence that e-mail could have on the doctor-patient relationship, and doctor-patient communication is unlikely to improve as a result of their use of e-mail.