This is the first article of a review of this important topic of doctor-patient communications that I will like to share with my colleagues. Your feedback is welcome.
Ingrid Alicea, M.D.
Secretary, Puerto Rico Psychiatric Society
"The Interactive Office: the office of the future"
The use of the internet and e-mails by physicians is increasing as a form of communication. Standards for appropriate and effective use are imperative. I will like to review the "AMA Guidelines for Doctor-Patient e-mail."
The American Medical Association Board of Trustees recommends that for those physicians who choose to utilize e-mails for selected patient and medical practice communications, the following communication guidelines be adopted.
1. Establish turnaround time for messages. Exercise caution when using
e-mail for urgent matters.
2. Inform patients about privacy issues.
Patients should know who besides addressee processes messages
during addressee’s usual business hours and during
addressee’s vacation or illness.
Whenever possible and appropriate, physicians should retain electronic
and/or paper copies of e-mails communications with patients.
3. Establish types of transactions (prescription refill,
appointment scheduling, etc.) and sensitivity of subject
matter (HIV, mental health, etc.) permitted over e-mail.
4. Instruct patients to put the category of transaction in the
subject line of the message for filtering:
prescription, appointment, medical advice, billing question.
5. Request that patients put their name and patient
Identification number in the body of the message.
6. Configure automatic reply to acknowledge receipt of messages.
7. Send a new message to inform patient of completion of request.
8. Request that patients use autoreply feature to acknowledge
reading clinicians message.
9. Develop archival and retrieval mechanisms.
10. Maintain a mailing list of patients, but do not send group
Mailings where recipients are visible to each other. Use blind
copy feature in software.
11. Avoid anger, sarcasm, harsh criticism, and libelous references
to third parties in messages.
12. Append a standard block of text to the end of e- mail messages
to patients, which contains the physician’s full name,
contact information, and reminders about security and
the importance of alternative forms of communication
for emergencies.
13. Explain to patients that their messages should be concise.
14. When e-mail messages become too lengthy or the correspondence
is prolonged, notify patients to come in to discuss or call them.
15. Remind patients when they do not adhere to the guidelines.
16. For patients who repeatedly do not adhere to the guidelines,
it is acceptable to terminate the e-mail relationship.
