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Research ArticleOriginal Article

Enhancing Doctor-Patient Communication Using Email: A Pilot Study

Shou Ling Leong, Dennis Gingrich, Peter R. Lewis, David T. Mauger and John H. George
The Journal of the American Board of Family Practice May 2005, 18 (3) 180-188; DOI: https://doi.org/10.3122/jabfm.18.3.180
Shou Ling Leong
MD
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Dennis Gingrich
MD
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Peter R. Lewis
MD
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David T. Mauger
PhD
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John H. George
PhD
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  • Article
  • Figures & Data
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Article Figures & Data

Figures

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  • Figure 1.
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    Figure 1.

    Patient satisfaction with the convenience of contacting doctor (P < .0001).

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    Figure 2.

    Patient satisfaction with the amount of time spent to contact doctor (P < .0001).

Tables

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    Table 1.

    Selected Characteristics of Participating Physicians at Baseline

    CategoriesE-mail GroupControl Group
    Age (years)
        30 to 4922
        50 to 6522
    Sex
        Female12
        Male32
    Average number of years in practice15.321.3
    Use e-mail daily100%50%
    Use e-mail 2 times per week0%50%
    “I find it easy to use e-mail”
        Agree to strongly agree100%50%
    Geriatric Practice50%50%
    “I would consider communicating via e-mail with patients”
        Yes11
        Not sure33
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    Table 2.

    Selected Characteristics of Participating Patients at Baseline

    CategoriesE-Mail Group(N = 67)Control Group(N = 33)
    N%N%
    Age (years)
        30 to 491241.8721.2
        50 to 651735.81957.6
         >653822.4721.2
    Sex
        Female3349.31854.5
        Male2943.31442.4
        Missing data51
    Average number of years in practice8.611.3
    Highest level of education completed
        High School1725.4618.2
        College2334.31442.4
        Graduate School2638.81236.4
        Missing data11
    I find it easy to use e-mail
        Agree to strongly agree5886.52987.9
    The number of hours spent using my computer each week
        <1 hour4600
        1 to 10 hours3349.31648.5
        10 to 20 hours1217.9515.2
        >20 hours1826.81133.3
        Missing data1
    Use internet for*
        Health information47582369.7
        Entertainment2632.11648.5
        News4231.92369.7
        Business/finance3644.41957.6
        Shopping3745.71751.5
    • * Responses are not mutually exclusive.

    • View popup
    Table 3.

    Physician Self-Reported Log on Non–E-Mail and E-mail Messages from Patients

    Log EntriesE-mail PhysicianControl Physician
    WeekE-1E-2E-3E-4AverageC-1C-2C-3C-4Average
    Number of non–e-mail messages115417951523372
    24647806045283152
    33228103312157
        Average3138.687.347.351.139.340.3
    Average time/day spent addressing messages (in minutes)1112936.2602027.42885
    2153563.45620.41929.250
    3102940.6627.68.75550
        Average123146.759.337.322.518.337.461.735
    Average time per message (in minutes)13.73.52.35.91.92.84.25.9
    21.63.73.94.72.33.44.75.0
    31.565.11.96.01.84.83.8
        Average2.34.12.75.53.72.04.64.93.8
    Number of e-mails in 6 months801212870
    Number of e-mails per week0 to 11 to 40 to 50 to 1
    Approximate time per e-mail (in minutes)1 to 31 to 31 to 21 to 5
    • View popup
    Table 4.

    Categories and Response Time of Messages

    E-mailPhone
    N%N%
    Categories(N = 299)(N = 732)
        Informational9532375
        Medical condition/consult933119927
        Medication481614520
        Administrative4314.327037
        Test results206.78111
    Response Time(N = 180)(N = 340)
        Same day683828483.5
        1 day5329.44413
        2 days2815.661.8
        3 days13751.55
        4 days181010.3
    • View popup
    Table 5.

    Guidelines for E-mail Communication between Physicians and Patients23

    Establish turnaround time for messages.
    Inform patients of the appropriate usage of e-mail.
        Do not use e-mail for urgent matters or medical emergencies (such as chest pain, shortness of breath); instead call 911 or the office.
        Do not use e-mail for sensitive matters (HIV, mental health issues, etc)
        E-mail is best suited for brief communications. Office appointments are more appropriate for more complex issues.
        E-mail communication is not a substitute for medical examination.
    Put the type of transaction (such as prescription refill, referral, medical advice, etc) on the subject line.
    Include name and patient identification number in the body of the message.
    If a reply is needed before an e-mail is received from the physician, call the office.
    Inform patients of privacy issues
        The potential risk of the e-mail being read by a hacker or patient employer if patient is using e-mail at work..
        The e-mail will be included as part of the medical record.
        Office staff may handle the message.
        Establish with whom and under what circumstances the physician may share the patient’s e-mail, such as consulting another physician. (When consulting another physician by e-mail, consider omitting the patient’s name and e-mail address).
        Patient’s e-mail address will not be used for marketing purposes.
    Use automatic reply to acknowledge the receipt of messages.
    Use “out-of-the-office” automatic reply and instruct patients on whom to call for assistance
    Request patients to reply and confirm the receipt of the physician’s message, especially important messages.
    Use professional language, avoiding anger, sarcasm, or harsh criticism.
    Develop archival and retrieval mechanisms.
    Use the blind copy feature when sending group mailings to maintain recipients’ privacy.
    Develop a patient-physician agreement and informed consent for the use of e-mail, including the above guidelines. This should be discussed and documented in the patient’s medical record.
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The Journal of the American Board of Family Practice: 18 (3)
The Journal of the American Board of Family Practice
Vol. 18, Issue 3
1 May 2005
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Enhancing Doctor-Patient Communication Using Email: A Pilot Study
Shou Ling Leong, Dennis Gingrich, Peter R. Lewis, David T. Mauger, John H. George
The Journal of the American Board of Family Practice May 2005, 18 (3) 180-188; DOI: 10.3122/jabfm.18.3.180

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Enhancing Doctor-Patient Communication Using Email: A Pilot Study
Shou Ling Leong, Dennis Gingrich, Peter R. Lewis, David T. Mauger, John H. George
The Journal of the American Board of Family Practice May 2005, 18 (3) 180-188; DOI: 10.3122/jabfm.18.3.180
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