Today I received two letters in the mail from medical practices in Connecticut. They were both routine, practice announcements about physician changes. What jumped out at me from both letters was that neither had an email address or a web site url. Here we are in the second half of the first decade of the twenty-first century and nobody at these multi-physician healthcare practices thought that it was important to offer the communications channel that a billion people around the world have adopted. It is understandable that physicians do not want to spend their time slogging their way through an email inbox, sorting out spam, reading life histories of patients, requests for second opinions of " medical" opinions of friends and family, etc. Then there is the legal side. Attorneys advise against giving online advice, warn about authentication of emails, express caution about liability when giving advice without actually seeing the doctor, etc. Just to round out the downside, I have no doubt that most doctors believe it is a choice — spend time with patients or spend time with email. On the other hand, the glass could be half full instead of half empty. There are numerous software packages and Internet services which offer encrypted, authenticated, secure, tamper-proof email capabilities. There are various challenge/response systems, such as spamarrest (which I use), that can ensure zero spam in the doctor’s inbox. The issue is not technical — the technology is available to be as safe and secure as wanted or needed. The issue is attitudinal and cultural in nature. Someone has probably done the study, but I believe that looking at the entire time spent and the entire experience for both physician and patient, that healthcare would be better with greater use of email. Physicians do not have time to shoot the breeze on the phone with patients for sure, but they do get phone calls and make phone calls, they do get interrupted by their assistants, patients do call back, and some get dissatisfied with a curt call-back at an inopportune time. Email is certainly not a substitute for "hands on" medicine but there are many cases when the hands are not needed. Doctors have incredible memories and know a lot about their many patients. Simple questions could be answered with simple answers. How many calls does the doctor get like "Is it ok to take two Tylenols for….". If you get through the switchboard and call center menus, good chance the receptionist may ask a nurse who may then ask the doctor and then tell the receptionist "Ok to take an extra Tylenol. If you don’t feel better in the morning call for an appointment to come see me". More sophisticated approaches will evolve as docs get into the swing of things with email and the web. Artificial intelligence will enable a patient to send an email and have it be automatically analyzed for keywords and then be presented to the doctor along with a set of possible responses which he or she can then customize easily and quickly. Appropriate reference material could be automatically appended. The web has empowered all of us to gain information and somewhat take control of our health, but an electronic connection — in addition to, not instead of — the hands on approach of seeing our doctors would be a big plus for healthcare. The other big change is the personal electronic health record. We can download our financial transactions every day into Quicken and be on top of our financial health. Get a blood test, however, and the data goes from our arm to a computer to a digital analysis and back to a faxed piece of paper. When we have that information in our PC, and this is happening for millions of people, we will know more about our chemistry than doctors do today. It may make some of our emails harder to respond to but ultimately will make us healthier. The patient centric world is coming, and quickly. Beyond that is the world of genomics. The breakthroughs in the next ten years will exceed the progress of the last one hundred years. There are other stories about healthcare here on patrickWeb in the healthcare section.