E-mail a great office tool, but sometimes you need to talk

How many times has this happened to you? A member of your staff e-mails a question about a patient record, which you promptly answer between patient appointments. Fifteen minutes later, when you check e-mail again, you find a follow-up question to the query you just answered.

This could feasibly continue for a few more exchanges, or it could end, but not without a final note from the staff member thanking you for your assistance. Either way, you spent extra time dealing with the issue over e-mail when a face-to-face conversation initially probably would have been quicker.

Physicians are almost always crunched for time, and e-mail certainly assists in multitasking. It promotes efficiency. You don't need to see the staff member to communicate. It helps you avoid having your desk cluttered with all those dastardly sticky notes.

However, there are some instances when e-mail can slow you down, and without proper protocols in place to avoid extra work, you and other staff members can find yourselves double-clicking unnecessarily.

While they insist e-mail is an integral part of practice today, some consultants suggest it shouldn't be seen as more than a good complement to other forms of communication.

"There's a tendency for e-mails to create more work, because some of these e-mail exchanges literally become a pingpong game," said Joyce Flory, PhD, a health care technology consultant based in Chicago. "Imagine multiple pingpong games going on at the same time."

Compared with the old days, when staff members would leave their work station or yell across the office to ask a question, using e-mail helps to create a less harried environment. And while the virtual inbox may be filled with unread messages, at least it doesn't create physical clutter.

The problem, though, is many unread messages may be inconsequential. Some may be copies of notes sent from one staff member to another, while others may be follow-up questions or thank-you notes, because no one wants to be accused of having bad e-mail etiquette.

Meanwhile, as you're sifting through the unimportant stuff, a more pressing message sits unopened until later in the day.

"You're trying to create a paper trail by e-mailing, but it's easy to miss or ignore messages too," Dr. Flory said.

Daniel Griffin, MD, an internist in Fort Collins, Colo., said his office avoids e-mail inefficiency by setting policies for both staff and patients. Because he communicates regularly with patients over e-mail, he quickly learned to set strict requirements for messages, such as specific phrases for subject headings. This allows for easy routing and prioritizing of messages.

The same principles apply to office staff as well, Dr. Griffin said. Clearly defined, brief messages, combined with a resolve on his end to keep messages from piling up, allows for an uninterrupted flow of work, he said.

"It's like voice mail in that you don't leave for lunch or go home if you haven't checked your messages," Dr. Griffin said.

Bruce Bagley, MD, medical director for quality improvement at the American Academy of Family Physicians, said his former practice in Albany, N.Y., had clear-cut policies regarding e-mails, that dispensed with wasteful messages of etiquette and confirmation. Thank-you notes were not necessary, and because the e-mail program was connected to an overall electronic medical record system, safeguards were automatically installed that would ensure both the physician and staff member knew when the duty was assigned and completed.

"A stand-alone e-mail system is a good step on the way to a fully integrated EMR," Dr. Bagley said. While there were moments when doctors would wonder why they weren't just picking up the phone, "on the other hand, if you have a system in place, you understand [the staff member] doesn't have to reply saying they got the message."

E-mail allows you to communicate without standing in front of the other person, but it also means you may have to wait for a response. With that in mind, Vijay Koli, MD, a family physician in San Antonio, Texas, says he will approach his office manager directly for things he needs right away, but if the issue isn't pressing, he will send an e-mail to the appropriate staff member.

As tempting as it may be to ask less important questions face to face, it means hunting down employees around the office and pulling them away from tasks they're doing at the time. That, of course, soaks up valuable time, Dr. Koli said.

That also could start making office processes a little too much like the old days, which would bring back nightmares for some doctors.

"In the old days, you had stacks of sticky notes everywhere," Dr. Bagley said.