How did I forget? I use a fax service that, for a reasonable monthly fee, assigns my own private fax number and allows me to send and receive via Internet. Received faxes appear in my email inbox as .pdf files. I can even receive a document in .pdf format, print it to a .jnt (Windows Journal) file, sign it with the stylus on my tablet pc, print back to .pdf format with CutePDF Writer (a free download), and fax it back, all without paper. One patient who had lost his phone actually did cancel his appointment via fax.
Of course videoconferencing via Skype, Google Video Chat, or other such service makes for a nice alternative to the voice only phone, but users can also send text messages. The chief limitation for me comes from the fact that I usually do not leave Skype running unless I have scheduled a patient contact. The notifications whenever someone signs distract me. Phone-based videoconferencing services like Tango depend on an operating telephone, so they do not add much.
This free and flexible service offers the capability of customizing an outgoing message to an identified caller. I almost tested this a couple weeks ago with the patient I mentioned in the earlier post who apparently was unable to access voicemails I had recorded. I could have recorded a message specifically for him containing more or less the same information I had left on his voicemail. The same capability used to "block" unwanted callers. Once you have identified a caller you want blocked simply so indicate through your Google Voice contacts list. The caller then encounters a message that says something to the effect that the number is no longer in service. An accommodating DEA agent actually confirmed for me that this works very nicely. (I recorded a custom outgoing message for a patient yesterday after several failed attempts to contact him by phone.)
Another more mundane feature probably available in one guise or another to many cell phone users actually allowed me to communicate with the patient mentioned above. Between Google Voice, my software-as-a-service contact management vendor, and my Android phone I am able to send unidentified callers as well as selected identify callers (usually all of my patients) directly to voicemail without ringing the phone. However, in the case of this particular patient I had not yet set his contact for immediate forwarding, so shortly before I intended to record a special outgoing message for him the phone rang identifying him, and, of all things, I actually picked up the phone and answered the old-fashioned way.
Google has indicated it plans to abandon the service in the near future. However, just yesterday it occurred to me that it might offer a solution to a different problem. I like to be able to hand my patients information at the end of a visit. Most commonly this would relate to a new medication I have just prescribed. However, I also like to be able to provide a business card when I refer someone to a psychotherapist or primary care physician. (I could write down the name and phone number, but the patient could never read it, and I always seem to run out of cards.) Since these kinds of information, as well as information about specific mental disorders, reside on Web pages, I would like to be able to efficiently provide the patient with a link. Google Wave appears to offer the capability of establishing a private forum for myself and the patient where I might post URL's for future reference by the patient. Since one can also leave messages or use a Wave for real-time text and even video chat, it could also serve in place of the telephone in a pinch. Furthermore, I can envision, with the patient's permission of course, inviting the patient's psychotherapist and primary care provider into the Wave.
Each of these modalities carries risks and benefits. In particular I wonder about the privacy and security of Wave. However, like with other modalities, we can always manage the content of the conversation in such a way as to maximize privacy. And as with other modalities such as e-mail, a written agreement can go a long way toward assuring that patient and physician understand rules and expectations.
After all, as far as I know it's still okay, even under HIPAA, to smile at the patient when you see him in public.