E-mailing With Patients: Think Before You ‘Send’

Most of my communication with physician clients is conducted via e-mail. And yet, as a patient, I have never communicated with any physician in this manner. Why is this?

The use of e-mail is said to offer numerous benefits to physicians, such as an increase in efficiency and productivity. E-mailing is often faster, easier, and can be written and reviewed at the convenience of both parties, so as to cause less interruption and distraction to physicians during the work day. Additionally, e-mails are great documentation for future reference and can be printed and placed in the patient chart. E-mails can effectively be used for communicating test results, reminding patients of appointments, making appointments, prescribing medications, and, in some cases, following up on treatments and patient wellness. When used properly, electronic communication can free up valuable physician and staff time and decrease the need for in-person appointments and phone consultations.

Like anything in healthcare, however, there are always some restrictions and concerns. When it comes to e-mail, I typically warn my clients of the following:

1. E-mail should not be used for emergencies. You should set a maximum response time (i.e., 48 hours) that you will be able to meet and let patients know ahead of time. Patients should also know that the e-mail may be reviewed by others in your office in order to achieve the fastest response.

2. Limit e-mail use to situations you are prepared to handle. If you want to refill prescriptions but not give medical advice via e-mail, that is your decision. Make this policy known to your patients and do not make any exceptions.

3. Make sure patients know what security measures you have taken with your e-mail system and that you are not responsible if they choose to allow access to their e-mail account by a third party.

4. Don’t use your personal e-mail address. Set up an address that can be discontinued should the e-mail “experiment” not work. Consider a trial e-mail period to see whether e-mail is an advantage or disadvantage for your practice.

5. Be careful what you put in writing. If you do not want to give advice, limit your e-mail conversations to non-diagnosis related advice such as referrals to specialists, clarifying statements you made to patients, or answering general questions. When patients are seeking medical advice for a condition that has not been examined in person, always have them schedule an appointment. Be aware of the laws in your state and malpractice risk that may be created by unclear or untimely advice on which a patient relies.

6. Consider whether access to e-mail is something for which you should charge patients. You may not be reimbursed for time spent e-mailing with patients, and establishing a safe e-mail system may be expensive. If you choose to charge patients, consult with legal counsel to make sure you are not violating any laws or payer contracts.

7. Consider whether your e-mails should contain a disclaimer. I have a client who provided e-mail advice to a patient one Friday evening who complained of flu-like symptoms. My client recommended fluids, rest, etc., and to come in for an appointment on Monday if he did not feel better. The patient’s condition worsened and he died over the weekend. At no time did the patient contact the physician again or go the emergency room, relying instead on the e-mail. Whether reasonable or not, patients often blindly follow a physician’s advice. Although liability can never be avoided completely, a disclaimer on your e-mails that reminds patients they cannot rely on e-mail advice without an exam might help. In addition, the disclaimer should remind patients to make an appointment or to go to the emergency room if symptoms persist or worsen. Legal counsel can help you draft something appropriate for your needs.

Although I cannot cover all of the benefits and risks of using e-mail in this blog, I do recommend careful consideration when introducing e-mail to your practice. Make sure you develop a written policy for how access to e-mail will work in your practice and have such policy acknowledged by participating patients before you push that “send” button.

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