We recently redesigned our hospital discharge summary and added my Internet email address. The general practitioners in our area have my telephone and fax numbers and use these frequently to contact me about our patients, and I hoped that those connected would make use of this additional facility to get in touch with me. Patients are given copies of their summaries to take home.
A few weeks ago I logged on to retrieve my mail and was surprised to find a message from a patient discharged only a week before. He had obtained my email address from his copy of the discharge summary and welcomed the chance to tell me that he was pleased with the care that he had received in hospital and was making a good recovery at home. There were, however, aspects of his care that he wanted to discuss but was embarrassed to talk about. He did not like to telephone or write and hoped that I could reply to his email address. To prove that he was indeed who he said he was, he gave me his postal address, hospital number, and telephone number. When I rang to verify I recognised his voice and convinced him that confidentiality was best maintained if we talked rather than communicated by email. Twenty minutes later all his questions were answered to his satisfaction.
Another way I have been contacted by a patient is with the talk facility on the Internet. If your computer is switched on and you are logged on and have this facility invoked people on other computers can attract your attention to say that they want to talk to you. If you respond the screen on your computer splits into two and communication begins. You type on one half while the caller's message appears on the other. For those who cannot type fast there are suggested abbreviations such as BCNU (be seeing you), IMHO (in my humble opinion), and ROTFL (rolling on the floor laughing).
Cyberspace is an exciting place for information exchange but sensitive information must not be disseminated this way until there are better safeguards. The password, encrypted to ensure that only the person authorised is allowed access to an email box, is not as secure as people think. There are programs now widely available to decipher passwords. The information on the computer in your office is as secure as the lock on the door. Once you connect your computer to the Internet the files on your system can be retrieved by anyone with the right resources. If your computer is connected to a network - for instance, in a hospital - the entire information on that network is vulnerable. Abuse can also occur m other ways. Anyone who knows my email address can send messages to others in my name, and the recipient has no way of knowing whether I was the initiator. Mail in transit can be intercepted and even altered. I agree with the BMA that doctors should not cooperate with the implementation of the NHS superhighway unless the government cam ensure that patients' medical records are secure. If Pentagon computers can be infiltrated by hackers almost to the point of starting a nuclear war what chance has the cash strapped NHS? The electronic password system will go down in history as one of the least innovative ways of protecting access to computer data.
DAVID SELLU is a senior lecturer in surgery in London, and his email address is david sellu@sellutec.demon.co.uk