When it's smart to e-mail your doc—and when it's not

As more and more doctors and patients exchange e-mail, protocols for a good, workable electronic relationship are being developed. E-mail "conversation" is great for non-emergency matters: problems or advice about a chronic disease, an appointment, test results, clarification of some item that came up during an office encounter, an overlooked question, a medication side effect, or any question requiring only a yes or no answer. And most often, it's a direct link to your doctor, without a telephone intermediary such as a nurse or assistant.

If you are interested in e-mailing your doctor, ask if he or she uses e-mail to communicate with patients, and if not, why not? If you do get that address, here are some ways to make your cyber-relationship run smoothly:

• Keep messages brief and to the point. A laundry list of concerns is better addressed in an office visit. It also helps if the subject line of your e-mail contains some clue as to its content, such as "medication question from YOUR NAME."
• Ask about security. Discuss security with your doctor beforehand to make sure it is adequate on both sides. Find out if you doctor uses special encrypted messaging software.  Ask if anyone else in your doctor's office reads his or her e-mail. If the email is on your work computer, your employer may have the right to access it. Your doctor may also ask if your home email is private or shared with others. HIPAA privacy laws would preclude the use of the latter.
• Use proper identification. Many e-mail addresses provide no clue as to the sender's real name, so be sure to sign your messages with yours. And since practices frequently include patients with duplicate names, also include your birth date and address.
• Know your doctor's turnaround time. Is he or she online practically every waking minute, or only checking messages every couple of days? The answer will help you determine when you should call rather than e-mail.
• Reread your message carefully. And recheck the To: box. Once you hit that "send" key, it's gone.
• Print out and save your e-mail questions and answers. Your doctor should do the same so they become part of your medical record.
• Never, ever use e-mail for an urgent or emergency situation. That's why 911 was invented.

—Marvin M. Lipman, M.D., chief medical advisor