“You’ve Got Mail”: Issues in Communicating With Patients and Their Families by E-Mail

“You’ve got mail” is a common refrain heard by 32 million America Online subscribers. Just as the telephone transformed both American society and the practice of medicine,¹ electronic communication (e-mail) is having a similar impact and will become an integral part of pediatrics. In the words of Jerome Kassirer, former editor of the New England Journal of Medicine, e-mail and electronic transfer of information has the potential to “induce cultural changes in the delivery of care even more revolutionary than any restructuring that is going on today.”²

In this issue Pediatrics, Kleiner and colleagues³ report the results of a survey of parent and physician attitudes toward the use of e-mail. The results are not surprising. The majority of families have access to e-mail, with access significantly related to family income and education. Most families want to communicate with us, and our practices, by e-mail. They express some concern about confidentiality. We, on the other hand, are quite ambivalent. Although only a small number of physicians were included in the survey, 79% indicated that they were not comfortable with e-mail communication with patients. These data are consistent with a recent survey of 834 physicians, which showed that 14% regularly or frequently use e-mail to provide clinical information to patients.⁴ Thirty-nine percent indicated that they do not currently e-mail clinical information but would if security/privacy were fully guaranteed, and 40% responded that even if issues of security/privacy could be resolved they would not e-mail information.

There are numerous benefits of e-mail.^{1,5, 6} Communication is dysynchronous; that is, the 2 parties involved do not have to be in contact simultaneously to “speak with each other,” ending needless telephone-tag. Communication is rapid, relatively inexpensive, simple, and convenient. It is available day or …

Address correspondence to Howard Bauchner, MD, 91 E Concord St, Boston, MA 02118. E-mail: howard.bauchner{at}bmc.org