Help for Physicians Contemplating Use of E-mail with Patients

When physicians are asked whether they would communicate electronically with their patients, they often ask what range of topics would be discussed. In this issue of JAMIA , White et al. from the University of Michigan1 begin to answer this question through a carefully done content analysis of e-mail messages sent from patients to their physicians.Three-fourths of physicians do not use e-mail or other forms of electronic messaging with their patients,2 and only about 5% do so regularly, even though patients, when asked, indicate that they would like to use e-mail with their physicians. Physicians express concerns about time requirements, reimbursement, security, liability, and, although not explicitly discussed in surveys, something I call “fear of the unknown.” Studies have been done or are ongoing that look at workflow and reimbursement. Security is not easily studied—physicians must learn that it is most prudent to use secure messaging when practical.3 The biggest threats to security are low-tech ones: failure to log off or use a screen saver, misaddressing e-mail messages, sharing e-mail accounts, and using employer-owned e-mail systems.Liability issues remain to be studied. Although there is no case law regarding e-mail use in patient care, it is reasonable to assume that eventually a patient will sue a physician for something stated in an …