Private Practice Success 2(1):3, 2003. © 2003 Advisory Publications

E-mail will be an increasingly common communication method between physicians and patients. To use it effectively and cover your medicolegal rear end, you'll need to develop a policy detailing how you, your staff and even patients should use e-mail.

Doing that requires a well-planned effort, but the cornerstone of any policy is message content. Following sound message rules is the best way to avoid trouble when using e-mail with patients. If you don't put anything inappropriate into your messages, there's very little chance they'll come back - or be forwarded - to cause you problems.

12 Rules

We compiled this list of 10 rules for outbound messages from the guidelines on physician-patient e-mail from two organizations: the American Medical Informatics Association and the American Medical Association (AMA). See the box to the right. And we've added two rules of our own to create an even dozen.

Using these guidelines for your message body, subject line and recipient fields will greatly reduce many potential problems. Several of these boilerplate components can be handled automatically by including them in a message form or signature that your e-mail client software then automatically inserts in every out-bound message.

1. Don't deliver bad news via e-mail.

2. Always address recipients using the "bcc" field when sending a message to more than one person. (Wherever possible, send messages to a single recipient).

3. Use your e-mail client's acknowledgement request feature with any e-mail you send to a patient. Also instruct patients to reply in the body of your message.

4. Never forward patient-identifiable information to a third party via e-mail, without the patient's express permission.

5. Avoid anger, sarcasm, harsh criticism or any potentially libelous references to third parties in outbound messages. Once you send it, you have no control over where a patient sends that message.

6. Inform patients that refusing to honor your e-mail policy may cause you to suspend e-mail communication with that patient.

7. Use a banner at the top of each e-mail message such as: This is a CONFIDENTIAL medical communication.

8. Append a standard block of text to the end of e-mail messages. Include the physician's full name, contact information, and reminders about security and the importance of alternative forms of communication for emergencies.

9. Copy any message containing medical information to a patient's medical record.

10. Double check all "To" fields before sending a message.

And our two rules:

11. If message content falls outside your policy parameters, call the patient. If you can't call promptly, send a generic message telling the patient when you expect to call.

12. Used standard subject lines defined by your e-mail policy.