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Submitted on August 26, 2003
Accepted on March 16, 2004
Affiliation of the authors: 1 Office of Medical Education, University of Michigan Medical School, Ann Arbor, MI; 2 Global REACH (Research Education and Collaboration in Health), University of Michigan Medical School, Ann Arbor, MI; 3 Global REACH (Research Education and Collaboration in Health), University of Michigan Medical School, Ann Arbor, MI; Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI; 4 Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
* To whom correspondence should be addressed.
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 examines the content of a random sample of patient-physician e-mail messages to determine the validity of those concerns.
Design Qualitative analysis of patient-physician e-mail messages.
Measurements A total of 3007 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 (82.7%) 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.
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