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Opinion 5.026 - The Use of Electronic Mail

Electronic mail (e-mail) can be a useful tool in the practice of medicine and can facilitate communication within a patient-physician relationship. When communicating with patients via e-mail, physicians should take the same precautions used when sending faxes to patients. These precautions are presented in the following considerations:

(1) E-mail correspondence should not be used to establish a patient-physician relationship. Rather, e-mail should supplement other, more personal, encounters.

(2) When using e-mail communication, physicians hold the same ethical responsibilities to their patients as they do during other encounters. Whenever communicating medical information, physicians must present the information in a manner that meets professional standards. To this end, specialty societies can provide specific guidance as to the appropriateness of offering specialty care or advice through e-mail communication.

(3) Physicians should engage in e-mail communication with proper notification of e-mail’s inherent limitations. Such notice should include information regarding potential breaches of privacy and confidentiality, difficulties in validating the identity of the parties, and delays in responses. Patients should have the opportunity to accept these limitations prior to the communication of privileged information. Disclaimers alone cannot absolve physicians of the ethical responsibility to protect patients’ interests.

(4) Proper notification of e-mail’s inherent limitations can be communicated during a prior patient encounter or in the initial e-mail communication with a patient. This is similar to checking with a patient about the privacy or security of a particular fax machine prior to faxing sensitive medical information. If a patient initiates e-mail communication, the physician’s initial response should include information regarding the limitations of e-mail and ask for the patient’s consent to continue the e-mail conversation. Medical advice or information specific to the patient’s condition should not be transmitted prior to obtaining the patient’s authorization. (I, IV, VI, VIII)

Issued June 2003 based on the report "Ethical Guidelines for the Use of Electronic Mail between Patients and Physicians," adopted December 2002, (AJOB 2003; 3(3))