Intended for healthcare professionals

Personal Views

Email contact between doctor and patient

BMJ 1999; 318 doi: (Published 22 May 1999) Cite this as: BMJ 1999;318:1428
  1. Badal Pal (bpal{at}, consultant rheumatologist
  1. Manchester

    The medical profession has been ahead of business and industry in its use of the telephone, but this is not the case with regard to its modern counterpart—email. However, with the rapid increase in the use of the internet the importance of email and its impact on health care cannot be ignored.

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    Face to face consultations are currently supplemented by mailed or faxed letters and telephone messages, but much more rapid communication is now available to patients and healthcare professionals via email. Email has many advantages that the others lack. For example, it is a direct means of contact between patients and doctors and is reassuring for the patients to know that the messages will be received. Doctors can provide follow up and continuity of care unavailable through other means. They can clarify advice previously given and point patients to patient information materials and other resources available on the internet. They can respond to more questions from more patients in a shorter time.

    They can respond to more questions from more patients

    It is estimated that more than 40% of patients in the United States use email to contact health professionals. Up to 90% of these patients correspond with their doctors not only on the mundane aspects of their care, such as repeat prescriptions, arranging appointments, or obtaining information on laboratory results, but also on important and sensitive matters.

    Recent surveys have shown that nearly half of an estimated 40 million US adults had resourced the internet within the pastyear to seek medical or health related information. It is estimated that there are at least 10 000 such sites on the world wide web. Many other thousands of self support groups, electronic bulletin boards, and mailing lists are also available. Despite such interest from patients only up to 2% of doctors in the United States currently offer the option of email contact with their patients and the figure is probably even smaller in Britain.

    The American Medical Information Association has recently published guidelines for email communication between doctor and patient. These apply to electronic communication within an established partnership, and so the position is not so clear, for example, with regard to unsolicited email from patients. Problems can be reduced by paying attention to informed consent, confidentiality, and record keeping of email exchanges.

    Some people think that email communication between patient and doctor is another example of inequity in the health service. But households with less than average income may be able to access the internet and email. In 1997 approximately 60% of public library systems offered some form of public access to the internet and it is presumed that by the year 2000 nearly every library will offer such services in the United States. Other public facilities may also provide public access terminals.

    Patients want to know more than they can obtain from the normal clinic based consultation, and they might find contact on the information super highway less intimidating than face to face dialogue with their doctors. On the other hand, doctors may be reluctant to offer email contact for fear of increasing workload and uncertainty about payment for the time involved. There is, however, a great potential for doctors to allow patients email contact under appropriate situations, and they might consider establishing their own web pages, featuring the most frequently asked questions. Other facilities might include departmental information, on line appointments, links to high quality health databases, and directories of support groups. Confidentiality, litigation, and security concerns can be addressed by encrypting messages or by adding a hyperlink disclaimer.