BMJ  2004;329:E327 (16 October), doi:10.1136/bmj.329.7471.E327

Following are edited excerpts from the Rapid Responses generated by these articles, all of which can be read in their entirety at http://bmj.bmjjournals.com/cgi/eletters/329/7463/435 and http://bmj.bmjjournals.com/cgi/eletters/329/7463/439.—Editor

BMJ USA: Letter

RAPID RESPONSES FROM BMJ.COM

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Basic ethics to the grave?

This paper of Car is a problematic one. Of course, on-line and other methods of consultation could be helpful in certain cases. The prototype is the old story of first-time mothers calling their pediatricians in the middle of the night because of a mild fever, cough, or something like that.

However, the spread of this kind of "consultation" is highly dangerous. The basic Ethics and Bioethics principles avoid with huge points the medical conduct without the actual examination of the patient. The procedure described is not only unethical, but leaves patients in danger, without a clear risk-benefit conclusion.

Headache and Neurology Clinic Sao Paulo, Brazil

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Competing interests: Occasionally lecture or consult about IT and health care, including particularly the role of email.

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Letter

Way back when, and smoothly since

I imagine a flashback to A G Bell demonstrating his new device, the mayor of a small American city saying, "Marvelous, one day every town may have one of these," and in the background a spokesman for the medical association saying, "But it will never be useful [in] any part of medical practice," and when pressed, coming out with all the same arguments we see above in the Rapid Response.

I was pleased to see the reference to the American Medical Informatics Association position paper on email in clinical practice that Dr B Kane (then working at Apple) put together a decade before the end of last century. I was one of the participants in the discussions around that, and since that era have been using email steadily in general practice.

It isn't magic, it occupies a space between the telephone (which does, we now think, have some role in practice) and letters, and it doesn't disadvantage anyone who can read and type, or who has someone [on] hand who can do so, and has a phone line accessible, which is approximately the whole of the UK population now.

Moving a few percent of contacts away from synchronous (phone, in person) to asynchronous (email, web access forms, [text messaging]) in the period from 8:30 to 9:30 on Monday mornings is a boon to general practices.

Progress arises from small improvements and tools used in various ways. Email is both of those.

Exeter EX1 2QS, UK

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