Patients: Internet medicine is slow to catch on

More than 80 percent of California primary care doctors-excluding those in the Kaiser Permanente system-rarely communicate with patients online, according to a survey sponsored by the California HealthCare Foundation. Doctors in large groups are more averse to a cyber-relationship with patients than their solo colleagues, even though they're more likely to have an IT infrastructure that would make it possible. In contrast, 54 percent of Kaiser primary care doctors said they communicate with patients by e-mail either often or sometimes.

The survey doesn't explain why Kaiser doctors take a different approach to Internet medicine, but how they're paid could be the reason. In the fee-for-service world, e-mailing a patient is normally uncompensated work. However, Kaiser physicians, who are capitated and oriented toward comprehensive care, arguably have less cause to see patient e-mail as bad for their paychecks.