Suzanne Kreuziger is a registered nurse who uses e-mail almost exclusively to communicate with friends. But when it comes to reaching her doctor, there's a frustrating firewall.

AP

Suzanne Kreuziger, a registered nurse, wishes she could communicate with her physician through e-mail.

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The barrier is her doctor's own reluctance to talk to patients through e-mail.

"It makes sense to me to have the words laid out, to be able to re-read, to go back to it at a convenient time," the 34-year-old Milwaukee woman recently wrote on a social networking site. "If I were able to ask my physician questions this way, it would make my own health care much easier."

Ms. Kreuziger's experience is shared by most Americans: They want the convenience of e-mail for nonurgent medical issues, but fewer than a third of U.S. doctors use e-mail to communicate with patients, according to recent physician surveys.

"People are able to file their taxes online, buy and sell household goods, and manage their financial accounts," said Susannah Fox of the Pew Internet & American Life Project. "The health care industry seems to be lagging behind."

Doctors have their reasons for not hitting the reply button more often. Some worry it will increase their workload, and most physicians don't get reimbursed for it by insurance companies. Others fear hackers could compromise patient privacy – even though doctors who do e-mail generally do it through password-protected Web sites.

There are also concerns that patients will send urgent messages that don't get answered promptly. And any hitch raises the specter of legal liability.

Many patients would like to use e-mail for routine matters such as asking for a prescription refill, getting lab results or scheduling a visit. Doing so, they say, would help avoid phone tag or missing work.

Still, a survey conducted early last year by Manhattan Research found that only 31 percent of doctors e-mailed their patients in the first quarter of 2007.

Two major health insurers, Cigna Corp. and Aetna Inc., this year expanded pilot programs that compensate doctors who use a secure Internet site to make virtual house calls with patients.

Dr. Daniel Z. Sands, an assistant clinical professor at Harvard Medical School, is among the early adopters who doesn't get paid for e-visits. He sees communicating with patients online as no different from phoning them, a practice that also is not billable.

Since 2000, Dr. Sands has answered patient questions by logging onto a password-protected Web site of the Harvard-affiliated Beth Israel Deaconess Medical Center. He also sets his Treo to retrieve new messages every four hours. He mostly gets e-mails from patients seeking advice for new symptoms or updates from chronic disease sufferers.

Although Dr. Sands has had mostly positive experiences, one patient bombarded him with e-mails. She became pushy and sent some threatening messages.

"We sort of had this fight back and forth through electronic communication, which is absolutely the wrong thing to do. I should have picked up the phone and called her. Any message that takes more than two volleys back and forth should not be done by e-mail," Dr. Sands says.

The American Medical Association says e-mail should not replace face-to-face time with patients. The group's etiquette guidelines recommend talking to patients about the technology's limitations.