Email consultations in health care

Editor—Car and Sheikh's final conclusion, that making email communication more readily accepted as a part of routine medical practice should be a key objective of the UK NHS information technology strategy, may have unforeseen consequences for the NHS.¹,² They point out that demand has been mainly patient led, and their data, mostly from the United States, indicate that the demand is from wealthier, younger patients.

The United States has a different health system from the United Kingdom. What Americans want may not be what UK patients want. The two health systems also have different health policy goals. The policy goal of the NHS is generally accepted as equal access, based on need. Poor and elderly people are the most needy and the least likely to use the internet.¹,³ In each system, policy objectives often need to be traded off against each other.⁴ Using email for communication may offer choice but probably at the expense of access.

Technological solutions are often hailed as the answer to old problems, but often the intended benefits are not as immediate or cheaper.⁵ Full research into the impact of a new technology is needed before any steps are taken to adopt it as the norm. We expect this of any new medication or device, so why not a new mode of consultation? Maybe this might be added to the remit of the National Institute for Clinical Excellence? If not, where do we stop? At text messaging consultations, or maybe mobile phone video consultations?