Patient Education Reinvented in the Digital Age

A physician’s use of e-mail raises significant legal issues, such as interstate licensing restrictions and potential liability issues. These are separate from ethical issues that must also be considered. Almost all guidelines state that there must be a prearranged agreement documenting the willingness of the clinician and the patient to communicate via e-mail. This agreement should be readily retrievable, preferably in an electronic medical record. E-mail communications are like letters and need to be well documented in the medical record.

The other thing to remember is that e-mails are always interpreted through the lens of the reader. The sender’s intent is not always necessarily communicated well, and one of the most important means of communication—body language—is not available. I learned early in my career never to handle sensitive issues through e-mails or texts, because your intent cannot always be accurately delivered and it can be easily misinterpreted. Instead, have a face-to-face encounter with your patients so you can effectively communicate with them.

One last thought regarding e-mail communications: They are not necessarily secure and may be widely distributed out of context. It is always much safer to use an electronic medical record portal that has encrypted texting and implied consent to communicate.

Dr. Lusk is director of the Boys Town Ear, Nose and Throat Clinic and Cochlear Implant Center at Boys Town National Research Hospital in Omaha, Neb. He may be reached at rodney.lusk@boystown.org.