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The American Medical Informatics Association, which has taken a lead role in defining the issues associated with email in the medical setting, defines patient-provider email as “computer-based communication between clinicians and patients within a contractual relationship in which the health care provider has taken on an explicit measure of responsibility for the client’s care.” There are wide ranges of issues inherent in email communications between a clinician and a patient. Consider the email shown in Fig. 12-1. Provider-provider patient-related email is not encompassed in this definition, but raises some of the same issues.
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A third kind of communication is email from a provider to a “client” with whom there is no contractual relationship. There are, for example, web sites, newsgroups, and discussion groups wherein a clinician undertakes to provide medical advice in the absence of a traditionally defined medical role. One example of a relatively successful site of this type is MyDoc.com, which provides web-based medical advice (in some states). This chapter will deal primarily with patient-provider and provider-provider email.
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Key Points
Email’s advantages include its ability to uncouple the communications of the two parties so that they don’t need to be at two ends of a phone line but can communicate more quickly than letters permit.
Email can be used for f/u, reinforcement, amplification, or education.
Email’s disadvantages include its similarity to a conversation but lack of the usual cues which permits ambiguous or disinhibited communications.
Email is also relatively insecure and therefore problematic for medical communications.
Email has advantages and disadvantages that are unique and differ from those of other medical communication formats.
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Advantages of Email Communication
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Email is well suited to the kinds of communication that are likely to occur between a provider and a patient or a peer. For example, it is asynchronous and therefore doesn’t require the simultaneous presence of both parties. This is ideal for busy physicians and other healthcare providers, who are not typically deskbound and are often difficult to reach (Fig. 12-2).
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Email is less formal than a letter (and less expensive) but more permanent and typically more structured than a phone conversation. It is equally well suited to the exchange of a quick question and answer, and more complicated interaction.
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