Judicious Utilization of Electronic Mail in Clinical Practice


As online utilization develops, so has patient demand for e-mail access to their doctors. Employing e-mail in psychiatric practice has numerous advantages but likewise some specific drawbacks. Advantages For you, e-mail’s rewards include:

• Minimized “phone tag” with patients • ability to reply to requests at your convenience

• An automatically rendered medical history

• Uncomplicated dispersion of handouts and references to patients, doing away with the need to store paper transcripts.

Employing e-mail likewise may facilitate patient understanding and adhesiveness. For instance, consider e-mailing appointment reminders or medicine instructions or requiring cognitive-behavioral therapy patients to transmit in day-to-day homework. E-mail’s advantages for patients include: • Expanded gratification and engagement in care

• Convenience

• More proficient interpreting of directions that can be reread vs spoken info that may not be remembered.

Many patients might be more at ease talking about sensitive subjects thru e-mail than in-person. In my practice, I have determined this to be the case with college students, especially those with anxiety disorders. For instance, a patient of mine with a history of trauma dropped out of treatment after disclosing facets of the trauma early on in therapy. He didn't reply to my telephone calls, but after many weeks he unexpectedly e-mailed me. After an email exchange about what occurred, he came back to therapy and came in each week for numerous years. I feel this affirmative result came about because he could get hold of me in a manner that furnished him a sense of distance, control, and refuge.

E-mail Rules of Thumb

Possible risk of malpractice is a drawback of utilizing email in clinical practice. Malpractice by definition necessitates two components:

• a patient-physician kinship— which uninvited e-mail in all likelihood may institute if a doctor imparts advice that the patient accepts

• a breach of responsibility that results in damage to the patient.

The American Medical Association’s sweeping guidelines indicate how doctors who employ e-mail may cut down their malpractice risk. Additionally, particular states might have rules regulating the employment of e-mail in clinical practice.

Do Not Diagnose or Handle by e-Mail

Diagnosis and treatment thru electronic mail could be regarded deficient care. Patients may not be forthcoming about symptoms in an e-mail, either because of worries about how symptoms may be comprehended or poor perceptiveness. The want of auditive and optic cues makes suitable appraisal challenging and can increase the chance of misdiagnosis and improper treatment. This is particularly accurate in psychiatry, where diagnosis can bank to a great extent on examining a patient’s physical display, including psychomotor demeanor, affect, and voice communication conventions. For instance, if a patient you're caring for with an SSRI for a depressive episode e-mails you about sensing anxiousness in the presence of other people, it might be tempting to diagnose a comorbid anxiety disorder. Yet, anxious feelings likewise can be induced by paranoia accompanying a developing initiative lifetime installment of mania with psychotic characteristics. Clues to this diagnosis—such as expansive affect, coerced oral communication, and psychomotor unrest—coulded be observed during an in-person appraisal but overlooked in an e-mail. For this reason, avoid creating new symptomatic appraisals or switching a treatment program grounded on an e-mail exchange. If you're tempted to do so, call up the patient to talk about the matter or require him or her to come in for an office visit. Specify e-mail limits Employing e-mail in clinical practice may be time-consuming, bestowing additional work to already jam-packed days. A subset of patients—such as those with personality troubles—could e-mail excessively, bring up matters that are unsuitable for e-mail, or attempt to establish permeable limits into the patient-physician kinship. Minimize these worries by distinctly delineating which issues are and are not suitable for e-mail. For instance, you could employ e-mail exclusively for appointment scheduling, medicine refill requests, and rendering instructions, handouts, and references, all of which could step-up practice efficiency. Many psychiatrists may be at ease talking about many curative matters thru e-mail or permitting patients to convey ideas and concerns during the week— without awaiting a response, to be handled during their following session. You could refuse to furnish your e-mail address to patients who might misuse the privilege and apprise them to telephone the office instead. Improper utilization of e-mail can be handled during a session as you would any other transference-countertransference or boundary issue, possibly rendering crucial curative gains.



“Under the care of Leo J. Borrell, M.D. since December 2001, I have seen a remarkable improvement in my mother’s condition. She is responding dramatically to the new regiment Dr. Borrell has prescribed”

- Beth Rose


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