Information technology

Email communications can benefit orthopaedic surgeons and their patients

9 March 2006

Orthopaedic surgeons and their patients should be aware of the advantages and potential pitfalls of communicating with each other online, according to a paper published in the March 2006 issue of the Journal of the American Academy of Orthopaedic Surgeons. The review of current data on physician–patient electronic communication found that due to the rise in patients using the Internet for communication and information, orthopaedic surgeons should consider incorporating this resource into their practices; but they should do so in a thought-out and systematic way.

Use of the Internet has increased exponentially among U.S. adults, from 18 million users in 1996 to 140 million in April 2002. As of December 2003, 69 percent of American adults were regularly online. One of the most common uses of the Internet is to obtain health or medical information, although users searching for health information may not have the same needs or interests as actual patients. "Health information" can also include exercise, diet and home remedies in addition to medical knowledge.

The paper notes that as many as 55 percent of patients with musculoskeletal conditions will have sought information related to their diagnosis prior to the actual office visit. Accurate online medical information may be a useful adjunct to traditional physician-patient interaction because it is readily available, wide in scope and can provide the patient with basic knowledge on a given topic. A subsequent clinical encounter may possibly be more efficiently spent refining information and answering the patient's specific questions. In addition, some patient concerns may be easily satisfied through the use of e-mail.

"Patients are researching their conditions online, and this can be a positive thing," explained lead author, J. Sybil Biermann, MD, Associate Professor in the department of orthopaedic surgery and Director of Musculoskeletal Oncology at the University of Michigan Health System, Ann Arbor, Mich. "We want our patients to be educated and engaged in managing their own health. Therefore, we need to partner with patients to use this resource to maximum effect."

This concept is also behind the American Academy of Orthopaedic Surgeons' (AAOS) patient-centred care initiative, Getting Better Together. The initiative calls for a partnership between the orthopaedic surgeon and patient to ensure patients and their families are informed, respected and involved in all decisions pertaining to musculoskeletal-related care and treatment. Key components to patient-centred care include open, honest communication between a patient and physician and ensuring physicians are responsive to patients' unique preferences, needs and values.

While electronic communication can be an important part of patient- centered care, orthopaedic surgeons should be aware of its potential legal and confidentiality pitfalls. For example, any plan to incorporate physician- patient electronic communication should include specific policies regarding issues such as patient privacy and conveying sensitive information. In addition, physicians who wish to refer patients to health information Web sites should review the site's content and consider the hosting organization before doing so.

"Orthopaedic surgeons and other physicians can take the lead in online health research by providing their patients with useful sites and other reliable resources," Dr. Biermann said. For example, the AAOS' public and patient education website, Your Orthopaedic Connection (  offers patients physician-reviewed information on orthopaedic conditions and treatments, injury prevention, wellness and exercise.

"Patients can then bring specific, informed questions when they visit their physicians," said Dr. Biermann. "However, patients also have a responsibility to consider the source of Internet-based health information, and to understand that not all of the information they find will apply to them."

An orthopaedic surgeon is a physician with extensive training in the diagnosis and nonsurgical as well as surgical treatment of the musculoskeletal system including bones, joints, ligaments, tendons, and nerves.

Abstracts and full text of the monthly, peer-reviewed Journal of the American Academy of Orthopaedic Surgeons (JAAOS) are available online at 

An advocate for improved patient care, the Academy is participating in the Bone and Joint Decade (  ) a global initiative in the years 2002-2011, to raise awareness of musculoskeletal health, stimulate research and improve people's quality of life. The Academy's Annual Meeting is being held March 22-26, 2006 in Chicago, see

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