If you're old enough, you probably remember visiting the doctor's office in the 1950s. It was like walking into a church. The waiting room was quiet, and when you met with the doctor, it was: "Yes, doctor. No, doctor. Whatever you say, doctor." Mostly it was: Speak when you're spoken to.

That kind of reverential tone has disappeared from medical practice, mostly for the better. Patients have much higher expectations of their caregivers and shop around to find clinicians who are willing to communicate, not just face to face but electronically as well.

A growing number of tech-savvy clinicians appreciate the change. Paula Hillard, MD, a gynecologist at Stanford University Medical Center, for instance, recognizes that despite all the challenges involved in communicating with patients via email, it's still a good idea.

Stanford Medical Center uses a Web tool called My Health in conjunction with its Epic electronic health record system to let patients "securely and confidentially email questions and get updates on labs," Hillard says. "These communications then become a part of the medical records." Patients also provide updates via email, telling Hillard, for instance, whether they're doing well on a new birth control pill or describing a menstrual period and asking whether to come in for an office visit. These email exchanges sometimes save the patient time and worry.

As more patients come to expect this kind of service, the key questions IT executives and forward-thinking doctors and nurses need answers to include:

>> What sort of electronic communications do patients want from their caregivers?

>> What are clinicians willing to provide?

>> Which e-tools can facilitate two-way communications, and are they right for your hospital or practice?

The Patient's E-Wish List

The empowered patient insists on being an active participant in his or her healthcare, Kevin Pho, MD, an advocate for the use of social media in medical practice, recently told Inspire, a patient-oriented healthcare website. "Some doctors … fear empowered patients and think that it's infringing on the traditional doctor-patient relationship," says Pho, a primary care practitioner in Nashua, N.H. "But I think the trend is toward more shared decision-making and having patients being partners in their healthcare."

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