Israel passed a Health Insurance law in 1995 that mandates healthcare services by healthcare funds (HMOs) for the entire population. There is competition among the funds to improve efficiency and provide optimal care to the satisfaction of their patients, while still meeting budgetary constraints. One of the ways to achieve these goals is the use of advanced means of communication such as provision of physicians’ cell phone numbers and email addresses to patients for those cases in which this form of communication can make patient-physician communication more efficient. The use of cell phones and email to reduce the work burden of clinic physicians and to improve patient-physician communication has been shown to be effective [
Patients often contact their physicians by cell phone [
Electronic communication is a revolutionary development in healthcare services [
In order to evaluate this development in the field of patient-physician communication one should assess the advantages and disadvantages of its use. Proper use of email can improve communication and serve as a primary instrument for consulting in the healthcare system [
Although provision of cell phone numbers [
Pregnant women comprise a unique population that needs monitoring over the course of pregnancy. Pregnancy entails potential condition-related complications on the one hand while necessitating increased monitoring of chronic diseases that are unrelated to gender or pregnancy on the other. This unique situation requires the professional skills of the gynecologist together with the ongoing care of the family physician. The latter knows the patients and their medical and biopsychosocial circumstances and information that is very important for the decision-making process. The mode of communication with the gynecologist and the family physician is important as well as its availability at times of need under these unique medical circumstances. Over the course of pregnancy women often feel a need to contact their physician about their pregnancy, per se, as well as any causes of concern that may arise or new and troublesome symptoms. To our knowledge no paper has been published to date on patient-physician communication among pregnant women.
In Israel the treatment and followup of pregnant women are carried out by family physicians as well as obstetricians and gynecologists. Deliveries are performed by obstetricians and midwifes, but not by family physicians. In the current study family physicians serve as a reference group for comparison with obstetricians. In Israel there is a combined residency program for obstetrics and gynecology, so for convenience we use the term gynecologist when referring to either gynecologists or obstetricians.
The primary aim of the study was to evaluate the use of cell phones or email by pregnant women to consult with their gynecologist or family physician and their use of the Internet to search for information on their pregnancy.
The secondary aims of the study were as follows: to assess whether pregnant patients have the cell phone number or the email address of their gynecologist or family physician, to compare how pregnant women consult with their gynecologist and family physician, to evaluate the advantages and disadvantages of these modes of communication, to assess the effect of patient age, educational level, and other sociodemographic variables on the preferred mode of communication, to assess use of Internet searches to obtain information on pregnancy-related issues, to improve our understanding of this new mode of healthcare service.
This was a cross-sectional study. Personal interviews were conducted with Hebrew-speaking pregnant women of 18 years of age or older who came to the Women’s Health Center of the Clalit Healthcare Services in Beer-Sheva for a routine pregnancy checkup and agreed to participate in the study. Women with cognitive problems and those who were unable to answer the questionnaire items were not included in the study.
The study instrument was a questionnaire completed by personal interview. The first part covered patient attitudes towards getting their physicians’ cell phone number and email address for medical consultations during pregnancy and use of the Internet to obtain medical information. The second part included patient sociodemographic data. The questionnaire was tested in a pilot study with 10 participants and was revised in light of their comments.
Statistical analyses were conducted with the SPSS software package; version 19.0. Statistical tests were used for differences between the two primary study groups. In univariate analyses the Chi-square test was used for categorical variables and
The Helsinki Committee of the Meir Medical Center approved the study (number 140/2012).
One hundred and twenty women participated in the study. Their mean age was
Sociodemographic and health characteristics of the study population (
Variable | Result |
---|---|
Age in years | |
Mean ± SD | 27.4 ± 4.3 |
Range | 18–38 |
Family status |
|
Single | 5 (4) |
Married | 115 (96) |
Place of residence |
|
Beer-Sheva | 71 (59) |
Nearby city | 20 (17) |
Agricultural settlement | 11 (9) |
Bedouin sector | 18 (15) |
Country of birth |
|
Israel | 98 (82) |
Former USSR | 12 (10) |
Europe | 5 (4) |
USA/Canada | 3 (3) |
Africa/Asia | 2 (2) |
Years of education | |
Mean ± SD | 11.8 ± 0.7 |
Range | 9–14 |
Present work status |
|
Employed | 82 (68) |
Student | 16 (13) |
Unemployed | 22 (18) |
Income | |
Low | 63 (53) |
Average | 43 (36) |
High | 14 (12) |
How would you rate your health condition? |
|
Excellent | 81 (68) |
Very good | 25 (21) |
Good | 4 (3) |
Reasonable | 8 (7) |
Poor | 2 (2) |
Do you suffer from a chronic disease? |
|
Yes | 12 (10) |
No | 108 (90) |
Population sector? |
|
Jewish | 93 (78) |
Bedouin | 27 (23) |
Number of children | |
Mean ± SD | 1.08 ± 1.31 |
Range | 0–7 |
Week of pregnancy | |
Mean ± SD | 20.87 ± 8.05 |
Range | 7–37 |
Attitudes towards medical consultation through cell phones.
Variable | Gynecologist | Family physician |
|
---|---|---|---|
How do you feel about getting your physician’s cell phone number? |
|||
Very interested | 111 (92.5) | 114 (95.0) | 0.747 |
Would not object | 8 (6.7) | 5 (4.2) | |
Not interested | 1 (0.8) | 1 (0.8) | |
Do you agree with the following statements regarding getting your physician’s cell phone number? (scale of 1–5) | |||
It could improve the relationship between us: | |||
Mean ± SD | 4.53 ± 0.78 | 4.58 ± 0.71 | 0.678 |
Range | 2–5 | 2–5 | |
It could improve my sense of security even if I do not use it: | |||
Mean ± SD | 4.53 ± 0.78 | 4.57 ± 0.71 | 0.604 |
Range | 2–5 | 2–5 | |
The cell phone is an effective mode of communication that could solve my problems: | |||
Mean ± SD | 4.28 ± 0.74 | 4.37 ± 0.71 | 0.377 |
Range | 2–5 | 2–5 | |
The cell phone can cut down on the number of clinic visits: | |||
Mean ± SD | 4.28 ± 0.74 | 4.33 ± 0.73 | 0.598 |
Range | 2–5 | 2–5 | |
The cell phone can reduce the number of emergency room visits: | |||
Mean ± SD | 4.28 ± 0.74 | 4.33 ± 0.74 | 0.602 |
Range | 2–5 | 2–5 | |
At what times would you call the physician? |
|||
I do not intend to call | 2 (2) | 2 (2) | 0.994 |
Only at appointed hours | 47 (39) | 49 (41) | |
Only during daytime hours (except Saturdays and holidays) | 56 (47) | 54 (45) | |
At all hours including nights, Saturdays, and holidays | 15 (13) | 15 (13) | |
Under which circumstance would you call your physician? |
|||
I do not intend to call | 1 (1) | 1 (1) | 0.945 |
Only in unusual circumstances | 75 (63) | 73 (61) | |
For any questions that I think I require a medical consultation | 44 (37) | 46 (38) | |
The physician should not be called because it could interfere with their privacy when they are not working (scale of 1–5): | |||
Mean ± SD | 3.94 ± 0.86 | 4.03 ± 0.98 | 0.450 |
Range | 2–5 | 1–5 | |
The physician should not be called because there are telephone centers that are active after clinic hours (scale of 1–5): | |||
Mean ± SD | 4.08 ± 0.89 | 4.20 ± 0.83 | 0.281 |
Range | 2–5 | 1–5 | |
The physician should not be called because in emergencies one can call for an ambulance or go to the emergency room (scale of 1–5): | |||
Mean ± SD | 4.31 ± 0.71 | 4.23 ± 0.83 | 0.423 |
Range | 2–5 | 1–5 | |
The physician should not be called because medical errors can occur if a physical examination is not performed (scale of 1–5): | |||
Mean ± SD | 3.67 ± 0.99 | 3.73 ± 1.03 | 0.646 |
Range | 1–5 | 1–5 | |
The physician should not be called because there is a risk of miscommunication (scale of 1 to 5): | |||
Mean ± SD | 3.92 ± 0.94 | 3.98 ± 0.97 | 0.627 |
Range | 1–5 | 1–5 | |
The physician should not be called because it can interfere with their clinic work (scale of 1 to 5): | |||
Mean ± SD | 4.00 ± 0.90 | 4.05 ± 1.00 | 0.684 |
Range | 1–5 | 1–5 | |
Have you asked for your physician’s cell phone number in the past? |
|||
Yes | 33 (28) | 29 (24) | 0.555 |
Do you have your physician’s cell phone number? |
|||
Yes | 72 (60) | 50 (42) | 0.004 |
Have you contacted your physician by cell phone since you became pregnant? |
|||
Yes | 46 (38) | 26 (22) | 0.005 |
One hundred and nineteen of the 120 participants have cell phones. Most of the participants were very interested in receiving the cell phone number of their gynecologist and family physician (92.5% and 95%, resp.). Most of them felt that having their physician’s cell phone number could improve the quality of their communication (4.53 for their gynecologist and 4.56 for their family physician on a scale from 1 to 5, with 5 representing strong agreement). The women also agreed that having their physician’s cell phone number would increase their personal sense of security even if they did not actually contact the physician. The women agreed that calling the physician during work hours could impair the physician’s work (4.0 for the gynecologist and 4.05 for the family physician).
In the majority of issues surveyed there were no statistically significant differences in the participants’ responses between gynecologists and family physicians. The exceptions were that more women had their gynecologist’s number than their family physician’s number (
Attitudes towards medical consultation through email.
Variable | Gynecologist | Family physician |
|
---|---|---|---|
How do you feel about getting your physician’s email address? |
|||
Very interested | 107 (89.2) | 106 (88.3) | 0.944 |
Would not object | 4 (3.3) | 5 (4.2) | |
Not interested | 9 (7.5) | 9 (7.5) | |
Do you agree with the following statements regarding getting your physician’s email address? (scale of 1–5) | |||
It could improve the relationship between us: | |||
Mean ± SD | 4.6 ± 0.69 | 4.58 ± 0.71 | 0.412 |
Range | 2–5 | 2–5 | |
It could improve my sense of security even if I do not use it: | |||
Mean ± SD | 4.59 ± 0.69 | 4.58 ± 0.71 | 0.456 |
Range | 2–5 | 2–5 | |
Email is an effective means of communication that could solve my problems: | |||
Mean ± SD | 4.33 ± 0.73 | 4.34 ± 0.72 | 0.457 |
Range | 2–5 | 2–5 | |
Email can cut down on the number of clinic visits: | |||
Mean ± SD | 4.38 ± 0.71 | 4.34 ± 0.72 | 0.667 |
Range | 2–5 | 2–5 | |
Email can reduce the number of emergency room visits: | |||
Mean ± SD | 4.38 ± 0.71 | 4.32 ± 0.75 | 0.500 |
Range | 2–5 | 2–5 | |
At what times would you email the physician? |
|||
I do not intend to call | 9 (8) | 9 (8) | 0.994 |
Only at appointed hours | 8 (7) | 7 (6) | |
Only during daytime hours (except Saturdays and holidays) | 50 (42) | 50 (42) | |
At all hours including nights, Saturdays, and holidays | 53 (44) | 54 (45) | |
Under which circumstance would you email your physician? |
|||
I do not intend to contact by email | 9 (8) | 9 (8) | 0.706 |
Only in unusual circumstances | 44 (37) | 38 (32) | |
For any question | 67 (56) | 73 (61) | |
The physician should not be sent an email because it could interfere with their privacy when they are not working (scale of 1 to 5): | |||
Mean ± SD | 3.34 ± 1.42 | 3.41 ± 1.36 | 0.697 |
Range | 1–5 | 1–5 | |
The physician should not be sent an email because medical errors can occur if a physical examination is not performed (scale of 1 to 5): | |||
Mean ± SD | 3.88 ± 0.93 | 3.81 ± 0.96 | 0.566 |
Range | 2–5 | 2–5 | |
The physician should not be sent an email because there is a risk of miscommunication (scale of 1 to 5): | |||
Mean ± SD | 3.08 ± 0.85 | 4.03 ± 0.87 | <0.0001 |
Range | 2–5 | 1–5 | |
The physician should not be sent an email because it can interfere with their clinic work (scale of 1 to 5): | |||
Mean ± SD | 3.20 ± 1.46 | 3.20 ± 1.47 | 1.000 |
Range | 1–5 | 1–5 | |
I see no reason why I should not get the physician’s personal email address (scale of 1–5): | |||
Mean ± SD | 4.16 ± 0.92 | 4.39 ± 0.93 | 0.055 |
Range | 1–5 | 1–5 | |
Have you asked for your physician’s email address in the past? |
|||
Yes | 27 (23) | 20 (17) | 0.255 |
Do you have your physician’s email address? |
|||
Yes | 73 (61) | 46 (38) | 0.0005 |
Have you contacted your physician by email since you became pregnant? |
|||
Yes | 41 (34) | 23 (19) | 0.009 |
One hundred and fourteen participants (95%) have email addresses. Most of the women were very interested in getting email addresses from their gynecologist (89.2%) and their family physician (88.3%). Most of them felt that having their physician’s cell phone number could improve the quality of their communication (4.6 for their gynecologist and 4.58 for their family physician). Similarly, the women agreed that having their physician’s cell phone number would increase their personal sense of security even if they did not actually contact the physician. They thought that having the cell phone number could help solve medical problems and reduce the number of visits to the clinic and emergency room. The women responded that calling the physician during work hours could impair the physician’s work to a moderate degree (3.2 for both the gynecologist and the family physician).
The participants thought that there is greater risk of impaired communication through email with their family physician (4.03) than with their gynecologist (3.08) (
A comparison of attitudes towards receiving the family physician’s cell phone number or email address.
Variable | Cell phone number | Email address |
|
---|---|---|---|
How do you feel about getting your physician’s cell phone number or email address? |
|||
Very interested | 114 (95.0) | 106 (88.3) | 0.035 |
Would not object | 5 (4.2) | 5 (4.2) | |
Not interested | 1 (0.8) | 9 (7.5) | |
Do you agree with the following statements regarding getting your physician’s cell phone number or email address? (scale of 1 to 5) | |||
It could improve the relationship between us: | |||
Mean ± SD | 4.57 ± 0.71 | 4.58 ± 0.71 | 0.913 |
Range | 2–5 | 2–5 | |
It could improve my sense of security even if I do not use it: | |||
Mean ± SD | 4.58 ± 0.71 | 4.58 ± 0.71 | 0.913 |
Range | 2–5 | 2–5 | |
Calls and email are effective means of communication that could solve my problems: | |||
Agree | 4.37 ± 0.71 | 4.34 ± 0.72 | 0.745 |
Do not agree | 2–5 | 2–5 | |
Calls and email can cut down on the number of clinic visits: | |||
Mean ± SD | 4.33 ± 0.73 | 4.34 ± 0.72 | 0.915 |
Range | 2–5 | 2–5 | |
Calls and email can reduce the number of emergency room visits: | |||
Mean ± SD | 4.33 ± 0.74 | 4.32 ± 0.75 | 0.917 |
Range | 2–5 | 2–5 | |
At what times would you call or email the physician? |
|||
I do not intend to call or send an email | 2 (2) | 9 (8) | <0.0001 |
Only at appointed hours | 49 (41) | 7 (6) | |
Only during daytime hours (except Saturdays and holidays) | 54 (45) | 50 (42) | |
At all hours including nights, Saturdays, and holidays | 15 (13) | 54 (45) | |
Under which circumstance would you call or email your physician? |
|||
I do not intend to call or contact by email | 1 (1) | 9 (8) | <0.0001 |
Only in unusual circumstances | 73 (61) | 38 (32) | |
For any question | 46 (38) | 73 (61) | |
The physician should not be called or sent an email because it could interfere with their privacy when they are not working (scale of 1 to 5): | |||
Mean ± SD | 4.03 ± 0.98 | 3.41 ± 1.36 | 0.0001 |
Range | 1–5 | 1–5 | |
The physician should not be called or sent an email because medical errors can occur if a physical examination is not performed (scale of 1 to 5): | |||
Mean ± SD | 3.73 ± 1.03 | 3.81 ± 0.96 | 0.876 |
Range | 1–5 | 2–5 | |
The physician should not be called or sent an email because there is a risk of miscommunication (scale of to 5). | |||
Mean ± SD | 3.98 ± 0.97 | 3.20 ± 1.47 | <0.0001 |
Range | 1–5 | 1–5 | |
The physician should not be called or sent an email because it can interfere with their clinic work (scale of 1 to 5): | |||
Mean ± SD | 3.20 ± 1.46 | 3.20 ± 1.47 | 1.000 |
Range | 1–5 | 1–5 | |
The family physician cannot help because I am pregnant: (scale of 1 to 5) | |||
Mean ± SD | 1.98 ± 0.68 | 2.06 ± 0.74 | 0.384 |
Range | 1–4 | 1–5 | |
I see no reason why I should not get the physician’s personal cell phone number or email address (scale of 1 to 5): | |||
Mean ± SD | 3.73 ± 1.05 | 4.39 ± 0.93 | <0.0001 |
Range | 1–5 | 1–5 | |
Have you asked for your physician’s cell phone number or email address in the past? |
|||
Yes | 29 (24) | 20 (17) | 0.149 |
Do you have your physician’s cell phone number or email address? |
|||
Yes | 50 (42) | 46 (38) | 0.598 |
Have you contacted your physician by cell phone or email since you became pregnant? |
|||
Yes | 26 (22) | 23 (19) | 0.631 |
There was no statistically significant preference for getting a cell phone number or email address or as to which would be more likely to improve communication with the family physician, provide a greater sense of personal security, or reduce the number of clinic or emergency room visits. More women said that they would prefer to contact their family physician by cell phone at predetermined days or hours compared with any hour of the day by email (
A comparison of attitudes towards receiving the gynecologist’s cell phone number or email address.
Variable | Cell phone number | Email address |
|
---|---|---|---|
How do you feel about getting your physician’s cell phone number or email address? |
|||
Very interested | 111 (92.5) | 107 (89.2) | 0.02 |
Would not object | 8 (6.7) | 4 (3.3) | |
Not interested | 1 (0.8) | 9 (7.5) | |
Do you agree with the following statements regarding getting your physician’s cell phone number or email address? (scale of 1 to 5) | |||
It could improve the relationship between us: | |||
Mean ± SD | 4.53 ± 0.78 | 4.60 ± 0.69 | 0.462 |
Range | 2–5 | 2–5 | |
It could improve my sense of security even if I don’t use it: | |||
Mean ± SD | 4.53 ± 0.78 | 4.59 ± 0.69 | 0.528 |
Range | 2–5 | 2–5 | |
Cell phone calls and email are effective means of communication that could solve my problems: | |||
Agree | 4.28 ± 0.74 | 4.33 ± 0.73 | 0.598 |
Do not agree | 2–5 | 2–5 | |
Cell phone calls and email can cut down on the number of clinic visits: | |||
Mean ± SD | 4.28 ± 0.74 | 4.38 ± 0.71 | 0.286 |
Range | 2–5 | 2–5 | |
Cell phone calls and email can reduce the number of emergency room visits: | |||
Mean ± SD | 4.33 ± 0.74 | 4.38 ± 0.71 | 0.286 |
Range | 2–5 | 2–5 | |
At what times would you call or email the physician? |
|||
I do not intend to call | 2 (2) | 9 (8) | <0.0001 |
Only at appointed hours | 47 (39) | 8 (7) | |
Only during daytime hours (except Saturdays and holidays) | 56 (47) | 50 (42) | |
At all hours including nights, Saturdays, and holidays | 15 (13) | 53 (45) | |
Under which circumstance would you call or email your physician? |
|||
I do not intend to contact by email | 1 (1) | 9 (8) | <0.0001 |
Only in unusual circumstances | 75 (63) | 44 (37) | |
For any question | 44 (37) | 67 (56) | |
The physician should not be called or sent an email because it could interfere with their privacy when they are not working: (scale of 1 to 5) | |||
Mean ± SD | 3.94 ± 0.86 | 3.41 ± 1.36 | 0.0001 |
Range | 2–5 | 1–5 | |
The physician should not be called or sent an email because medical errors can occur if a physical examination is not performed: (scale of 1 to 5) | |||
Mean ± SD | 3.67 ± 0.99 | 3.88 ± 0.93 | 0.091 |
Range | 1–5 | 2–5 | |
The physician should not be called or sent an email because there is a risk of miscommunication: (scale of 1 to 5) | |||
Mean ± SD | 3.92 ± 0.94 | 3.08 ± 0.85 | <0.0001 |
Range | 1–5 | 2–5 | |
The physician should not be called or sent an email because it can interfere with his clinic work: (scale of 1 to 5) | |||
Mean ± SD | 4.00 ± 0.90 | 3.20 ± 1.47 | <0.0001 |
Range | 1–5 | 1–5 | |
I see no reason why I should not get the physician’s personal cell phone number or email address: (scale of 1 to 5) | |||
Mean ± SD | 3.62 ± 1.05 | 4.16 ± 0.92 | <0.0001 |
Range | 1–5 | 1–5 | |
Have you asked for your physician’s cell phone number or email address in the past? |
|||
Yes | 33 (28) | 27 (23) | 0.371 |
Do you have your physician’s cell phone number or email address? |
|||
Yes | 72 (60) | 73 (61) | 0.895 |
Have you contacted your physician by cell phone or email since you became pregnant? |
|||
Yes | 46 (38) | 41 (34) | 0.502 |
There was no statistically significant preference for getting a cell phone number or email address or as to which would be more likely to improve communication with the gynecologist, provide a greater sense of personal security, or reduce the number of clinic or emergency room visits. More women said that they would prefer to contact their gynecologist by cell phone at predetermined days or hours compared with any hour of the day by email (
Characteristics related to conduct Internet searches on pregnancy.
Variable | Often | Sometimes | Never |
|
---|---|---|---|---|
Age in years | ||||
Mean ± SD | 27.99 ± 3.91 | 27.58 ± 4.38 | 21.13 ± 2.59 | <0.001 |
Range | 19–35 | 19–37 | 18–24 | |
Family status |
||||
Single | 4 (6) | 1 (2.2) | 0 | 0.517 |
Married | 63 (94) | 44 (97.8) | 8 (100) | |
Place of residence |
||||
Beer-Sheva | 50 (74.6) | 21 (46.7) | 0 | <0.001 |
Nearby city | 9 (13.4) | 9 (20.0) | 2 (25.0) | |
Agricultural settlement | 6 (9.0) | 5 (11.1) | 0 | |
Bedouin sector | 2 (3.0) | 10 (22.2) | 6 (75.0) | |
Country of birth |
||||
Israel | 52 (77.6) | 38 (84.4) | 8 (100) | 0.251 |
Other | 15 (22.4) | 7 (15.6) | 0 | |
Years of education | ||||
Mean ± SD | 12.8 ± 0.55 | 11.76 ± 0.609 | 11.13 ± 1.126 | 0.001 |
Range | 9–14 | 10–12 | 9–12 | |
Present work status |
||||
Employed | 54 (80.6) | 28 (62.2) | 0 | <0.001 |
Student | 9 (13.4) | 5 (11.1) | 2 (25.0) | |
Unemployed | 4 (6.0) | 2 (25.0) | 6 (75.0) | |
Income | ||||
Low | 25 (37.3) | 30 (66.67) | 8 (100) | 0.002 |
Average | 31 (46.3) | 12 (26.7) | 0 | |
High | 11 (16.4) | 3 (6.7) | 0 | |
How would you rate your health condition? |
||||
Excellent | 47 (70.1) | 27 (60.0) | 7 (87.5) | 0.778 |
Very good | 13 (19.4) | 11 (24.4) | 1 (12.5) | |
Good | 1 (1.5) | 3 (6.7) | 0 | |
Reasonable | 5 (7.5) | 3 (6.7) | 0 | |
Poor | 1 (1.5) | 1 (2.2) | 0 | |
Do you suffer from a chronic disease? |
||||
Yes | 7 (10.4) | 5 (11.1) | 0 | 0.617 |
No | 60 (89.6) | 40 (88.9) | 8 (100) | |
Population sector? |
||||
Jewish | 64 (95.5) | 29 (64.4) | 0 | <0.001 |
Bedouin | 3 (4.5) | 16 (35.6) | 8 (100) | |
Are you religious? |
||||
Yes | 17 (25.4) | 22 (48.9) | 8 (100) | <0.001 |
No | 50 (74.6) | 23 (51.1) | 0 | |
Number of children | ||||
Mean ± SD | 0.81 ± 0.925 | 1.53 ± 1.673 | 0.88 ± 1.126 | 0.013 |
Range | 0–4 | 0–7 | 0–3 | |
Week of pregnancy | ||||
Mean ± SD | 20.55 ± 7.83 | 21.89 ± 8.359 | 17.75 ± 8.013 | 0.366 |
Range | 7–37 | 7–36 | 11–35 |
Most of the women (60%) reported that they conduct Internet searches on pregnancy often but 76% never discussed the information obtained with their gynecologist and 81% never did so with their family physician. The mean age of women who conducted Internet searches on pregnancy was higher than those who did not (
The results of the study show that the participants were interested in receiving the cell phone number or email address of both of their treating physicians without any preference for either modality.
We found that most of the women were very interested in getting the cell phone number and email address of their gynecologist (92.5% and 89.2%, resp.) or family physician (95% and 88.3%, resp.). These findings are in contradiction to the results of other studies conducted in the same geographic region among Jews [
More pregnant women had their gynecologists’ cell phone number and/or email address and consulted with their gynecologist by electronic modes than with their family physician over the course of their pregnancy. A possible explanation for this finding is that pregnant women are usually healthy and have little need in general for contact with healthcare services or family physicians, so they turn to gynecologists during pregnancy because they perceive them as the natural address for pregnancy-related issues.
Telephone calls interrupt the routine work of the physician in the clinic, while communication through email does not, because the physician can relate to the patient who sent an email message when they are not with another patient [
Having the physician’s cell phone number and/or email address can give patients a sense of personal security even if they do not actually use it. If used, it can lead to a reduction in clinic and emergency room visits and a decrease in the work burden of physicians in clinics and in the hospital. The results of another study showed that use of email for medical consultation led to a significant reduction in emergency room visits [
In the present study we found that all the women who did not perform pregnancy-related Internet searches were Bedouin women who defined themselves as religious. This indicates that there are significant differences between the Jewish and Bedouin sectors of the population in terms of use of the Internet and email. This may stem from lower availability and accessibility of computers and other means of electronic communication in the Bedouin sector compared to the Jewish sector.
In a previous study on the attitudes of physicians in the Negev to providing their email addresses to their patients, 65% expressed concern that the absence of a physical examination could lead to misdiagnosis and treatment, 58% stated that in the case of emergency they would recommend that their patients visit the emergency room, and 57% believed that communication through email could impair the quality of care and were concerned about medical negligence suits [
In a world in which an increasing number of people have access to the Internet and email and use them for many and varied needs, the provision of healthcare services through electronic communication could become, in the future, a central modality of medical consultation. However, there is a glaring lack of controlled studies supporting this means of communication for medical services or providing information on how to integrate these technologies into the daily work routine of the physician [
The use of email for patient-physician communication also raises an important ethical issue. Studies conducted in northern Europe found that medical confidentiality could not be guaranteed using these technologies and as a result hospitals developed computerized systems in which patients can contact their physicians in a secure manner [
There are no clear regulations or guidelines in Israel regarding the use of cell phones, email, and social networks such as Facebook and Twitter for medical consultation and physicians use them as they see fit.
Although there are clear advantages to the use of cell phones and email for medical consultation, there are also disadvantages including invasion of the physician’s free time beyond their defined and compensated work hours, interruption to the provision of medical care for other patients during clinic work hours, and the risk of mistakes in medical decision making [
This study has several limitations, including the relatively small study population of 120 pregnant women, which may have limited statistical power and led to a type II error. Since the vast majority in the study were very interested in getting the cell phone numbers and email addresses of their gynecologists and family physicians it was not possible to conduct a logistic regression analysis to look for characteristics of the participating women that would predict whether they preferred one modality over the other. This study was conducted in a specific geographical region in women’s health clinic of the Negev region of Israel. Since there are significant differences relating to health and pregnancy in different classes and cultures, the results of this study cannot be generalized to all the populations of pregnant women in Israel and around the world. It is also possible that women who did not participate in the study, including women who do not come to the clinic for regular monitoring during pregnancy, could have different attitudes towards the study questions, thus leading to a potential bias.
Pregnant women in the Negev region do not have a preference between the use of cell phones or email for medical consultation with their gynecologist or family physician. The provision of the physician’s cell phone numbers or email address, together with provision of guidelines and resources, could improve healthcare services by reducing clinic and emergency room visits, providing a sense of personal security to patients, and improving the quality of the patient-physician relationship. Understanding the unique advantages and disadvantages of these modes of communication could lead to their effective use in different conditions, including treatment for pregnant women. To this end it is recommended to formulate ethical and legal guidelines relating to the use of cell phones and email for healthcare services.
We hope that the findings of this study will help further this understanding of the use of cell phones and email among pregnant women specifically and in healthcare services in general.
The authors declare that there is no conflict of interests regarding the publication of this paper.