Enhancing Doctor-Patient Communication Using Email: A Pilot Study

Shou Ling Leong; Dennis Gingrich; Peter R. Lewis; David T. Mauger; John H. George

doi:10.3122/jabfm.18.3.180

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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).

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Table 1.

Selected Characteristics of Participating Physicians at Baseline

Categories	E-mail Group	Control Group
Age (years)
30 to 49	2	2
50 to 65	2	2
Sex
Female	1	2
Male	3	2
Average number of years in practice	15.3	21.3
Use e-mail daily	100%	50%
Use e-mail 2 times per week	0%	50%
“I find it easy to use e-mail”
Agree to strongly agree	100%	50%
Geriatric Practice	50%	50%
“I would consider communicating via e-mail with patients”
Yes	1	1
Not sure	3	3

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Table 2.

Selected Characteristics of Participating Patients at Baseline

Categories	E-Mail Group(N = 67)		Control Group(N = 33)
Categories	N	%	N	%
Age (years)
30 to 49	12	41.8	7	21.2
50 to 65	17	35.8	19	57.6
>65	38	22.4	7	21.2
Sex
Female	33	49.3	18	54.5
Male	29	43.3	14	42.4
Missing data	5		1
Average number of years in practice	8.6		11.3
Highest level of education completed
High School	17	25.4	6	18.2
College	23	34.3	14	42.4
Graduate School	26	38.8	12	36.4
Missing data	1		1
I find it easy to use e-mail
Agree to strongly agree	58	86.5	29	87.9
The number of hours spent using my computer each week
<1 hour	4	6	0	0
1 to 10 hours	33	49.3	16	48.5
10 to 20 hours	12	17.9	5	15.2
>20 hours	18	26.8	11	33.3
Missing data			1
Use internet for^*
Health information	47	58	23	69.7
Entertainment	26	32.1	16	48.5
News	42	31.9	23	69.7
Business/finance	36	44.4	19	57.6
Shopping	37	45.7	17	51.5

* Responses are not mutually exclusive.

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Table 3.

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

Log Entries	E-mail Physician						Control Physician
Log Entries	Week	E-1	E-2	E-3	E-4	Average	C-1	C-2	C-3	C-4	Average
Number of non–e-mail messages	1	15	41	79	51		52		33	72
	2	46	47	80	60		45	28	31	52
	3	32	28	103	31		21		57
Average		31	38.6	87.3	47.3	51.1	39.3		40.3
Average time/day spent addressing messages (in minutes)	1	11	29	36.2	60		20	27.4	28	85
	2	15	35	63.4	56		20.4	19	29.2	50
	3	10	29	40.6	62		7.6	8.7	55	50
Average		12	31	46.7	59.3	37.3	22.5	18.3	37.4	61.7	35
Average time per message (in minutes)	1	3.7	3.5	2.3	5.9		1.9	2.8	4.2	5.9
	2	1.6	3.7	3.9	4.7		2.3	3.4	4.7	5.0
	3	1.56	5.1	1.9	6.0		1.8		4.8	3.8
Average		2.3	4.1	2.7	5.5	3.7	2.0		4.6	4.9	3.8
Number of e-mails in 6 months		80	121	28	70
Number of e-mails per week		0 to 1	1 to 4	0 to 5	0 to 1
Approximate time per e-mail (in minutes)		1 to 3	1 to 3	1 to 2	1 to 5

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Table 4.

Categories and Response Time of Messages

	E-mail		Phone
	N	%	N	%
Categories	(N = 299)		(N = 732)
Informational	95	32	37	5
Medical condition/consult	93	31	199	27
Medication	48	16	145	20
Administrative	43	14.3	270	37
Test results	20	6.7	81	11
Response Time	(N = 180)		(N = 340)
Same day	68	38	284	83.5
1 day	53	29.4	44	13
2 days	28	15.6	6	1.8
3 days	13	7	5	1.55
4 days	18	10	1	0.3

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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.