Increasing email consultations may marginalise more people

EDITOR—The explanations offered by Mechanic on why doctors feel stressed are both plausible and likely.1 As a general practitioner in the United Kingdom I am often at the receiving end of increased expectations of patients, as well as increasing guidance not only on how I should do more but also on how I should do it. I am thinking here, for example, of the guidelines from the National Institute for Clinical Excellence (NICE) and the national service frameworks.

I am, however, uncomfortable with Mechanic's proposed solution to the problem—namely, that doctors should spend more time consulting by email with their patients. In the United Kingdom internet access is related to socioeconomic class, with those living in a household headed by someone in a routine or semiroutine occupation accessing the internet less often compared with those living in households headed by someone in a managerial or professional occupation (23-36% v 68-87% in a one month period).2 Although computer ownership has increased in the United Kingdom from 18% in 1988 to 34% 1998-9, certain groups of the population are less likely to own computers. The most important of these are people aged 60 and over (4% ownership rate in 1998-9).3

Mechanic's proposed solution seems likely to marginalise old and poor people in favour of younger and socioeconomically advantaged people. It has long been recognised that those who need health care the most are least likely to receive it.4 By increasing the use of email consultations we may be at risk of using a cyber age solution that perpetuates an age old problem.