S. Terez Malka, MD, might not have written the book on e-mail communication among clinicians, but she would like to write the guidelines: Malka served as first author on “Professional E-mail Communication Among Health Care Providers: Proposing Evidence-Based Guidelines,” a report appearing online ahead of print in Academic Medicine. Malka, an assistant professor of emergency medicine and pediatric emergency medicine at Carolinas Medical Center in Charlotte, N.C., explained to The Clinical Advisor how outpatient providers can keep themselves out of e-mail trouble.

E-mail has become a primary form of communication for health-care providers. E-mail etiquette may impact professional reputation, lead to delays in response time, and potentially affect clinical outcomes, as Resendes and colleagues noted in Journal of Surgical Education (2012;69[3]:393-403). Here are a few ways to avoid the most common pitfalls:


Err toward formality. Work-related emails should be considered a part of the medical record and viewed as just slightly less formal than a printed letter. Casual language, sarcasm, and humor may all be misinterpreted in an e-mail. In a survey of surgeons discussed in the Resendes study mentioned above, most agreed that incorrect grammar or spelling, off-color humor, and use of incomplete sentences were undesirable in work-related e-mails.


Be clear and concise. A study of outpatient consultation requests by Bergus and colleagues in Journal of Telemedicine and Telecare (2006;12[1]:33-38) found that consultants were more likely to respond quickly and with a definitive answer when the original e-mail contained all relevant patient information and a single, specific, detailed clinical question. A general rule of thumb is that an e-mail should be fully visible upon opening without the recipient needing to scroll down.


Double-check the address line. Use extreme caution when using the “reply all” function and the “cc” line, and make sure that your e-mail is correctly addressed to the proper recipient and is relevant to all addressees.


Be cautious with protected health information. Patient data should be transmitted with extreme caution, through a private or secured computer and an encrypted network. Such data should not be sent from, nor accessed on, unsecured hand-held devices, public settings, or commercial e-mail services such as Gmail or Yahoo, as DeVille and Fitzpatrick cautioned as far back as 2000 in Seminars in Pediatric Surgery (2000;9[1]:24-34). (195-4)


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