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.