E-mail communication in paediatrics: Ethical and clinical considerations

Question 1

What are recommendations re: general communication via email?

Answer 1

1. Be courteous, be concise, do not expect an immediate answer, and check e-mails for content, spelling and grammar before sending. Be careful with abbreviations.
2. E-mail is a less formal means of communication than a letter; be cognizant of the potential for misunderstanding.
3. Sensitive issues are more appropriately handled face-to-face. Do not send or reply to an e-mail when you are angry; wait until you have calmed down (24 h is a good rule of thumb).
4. Be aware of the type of security provided by your server, and what you can do to enhance confidentiality, authenticity and integrity of e-mail transmission, such as firewalls, encryption and digital signatures

Question 2

What are recommendations re: electronic consultation?

Answer 2

1. Can be viewed as a formal consultation. Depending on the complexity of the patient’s condition, an official written consultation may be more appropriate.
2. In a consultation, use clear patient identifiers, but be cognizant of the security of your e-mail network

Question 3

What are recommendations re: electronic “curbside” consultation and discussion groups?

Answer 3

If you have not seen the patient, advice should be limited to general comments about a disease, a treatment modality or recent research. Consider including a disclaimer in your postings (consult your liability insurance provider for suggestions).

Question 4

What are recommendations re: electronic communications with current patients or their parents?

Answer 4

1. Written policies should address how questions will be answered, who will respond, expected response times, how to ensure that the e-mail has been received, document retention practices and the limits of confidentiality
2. Before physicians and patients/parents begin to communicate electronically, patients/parents should be informed of the potential risks, benefits and policies for e-mail communication.
3. Communication with established patients should relate to previously diagnosed conditions.
4. Maintain a professional relationship in e-mail despite the informal nature of the medium.
5. E-mail communication relating to questions of a personal or sexual nature should not take place.

Question 5

What are the recommendations re: email communication with individuals seeking medical advice who are not patients?

Answer 5

1. Responding to unsolicited e-mail communication from individuals who are not current patients or parents is not advisable. A standard response might include the following:
   - “E-mail is not a substitute for a medical evaluation; it is unwise and unprofessional for a physician to provide advice without a full history and physical examination”.
   - “I do not offer medical advice via e-mail for non-patients”.
   - “If you wish to make an appointment with me, please call my office at (number provided)

Question 6

What are the recommendations regarding personal email?

Answer 6

Separate personal from professional email