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A Content Analysis of E-mail Communication between Patients and Their Providers: Patients Get the Message

Affiliations of the authors: Office of Medical Education, University of Michigan Medical School, Ann Arbor, MI (CBW); Global REACH (Research Education and Collaboration in Health), University of Michigan Medical School, Ann Arbor, MI (CAM, DTS); Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI (DTS, SJK); Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI (DTS, SJK)USA

Correspondence and reprints: Casey B. White, University of Michigan Medical School, Learning Resource Center, 3960 Taubman Medical Library, 1135 East Catherine Street, Ann Arbor, MI 48109-0726; e-mail: <bcwhite{at}umich.edu>.

Received for publication: 08/26/03; accepted for publication: 03/16/04.

Objective: E-mail use in the clinical setting has been slow to diffuse for several reasons, including providers' concerns about patients' inappropriate and inefficient use of the technology. This study examined the content of a random sample of patient–physician e-mail messages to determine the validity of those concerns.

Design: A qualitative analysis of patient–physician e-mail messages was performed.

Measurements: A total of 3,007 patient–physician e-mail messages were collected over 11 months as part of a randomized, controlled trial of a triage-based e-mail system in two primary care centers (including 98 physicians); 10% of messages were randomly selected for review. Messages were coded across such domains as message type, number of requests per e-mail, inclusion of sensitive content, necessity of a physician response, and message tone.

Results: The majority (82.8%) of messages addressed a single issue. The most common message types included information updates to the physicians (41.4%), prescription renewals (24.2%), health questions (13.2%), questions about test results (10.9%), referrals (8.8%), "other" (including thank yous, apologies) (8.8%), appointments (5.4%), requests for non-health-related information (4.8%), and billing questions (0.3%). Overall, messages were concise, formal, and medically relevant. Very few (5.1%) included sensitive content, and none included urgent messages. Less than half (43.2%) required a physician response.

Conclusion: A triage-based e-mail system promoted e-mail exchanges appropriate for primary care. Most patients adhered to guidelines aimed at focusing content, limiting the number of requests per message, and avoiding urgent requests or highly sensitive content. Thus, physicians' concerns about the content of patients' e-mails may be unwarranted.