Your inquiry raises the caution flag on several fronts that you will want to think through before you say “yes” or “no” to your patients.

The advantage to email is that it can be written and sent, or retrieved and read, anywhere at any time.  You and your patient do not need to be available at the same time, thereby eliminating phone tag.  Another plus is that emails automatically create a written, permanent record that may be referred to as needed by you or your patients.

But (and there is always a “but”), there are risks as well. Unless some type of encryption is used, email may not be as secure and confidential as you (or the patient) would like and expect it to be. Encryption is not easy to use, presuming a level of computer competence that many users do not have.  Firewalls are another line of defense, but you must do your homework or consult with an information technology specialist to decide upon the firewall that is best suited for your practice and purposes.

There are other concerns, too. For example, many individuals don’t wish their real identities to be known as they surf the internet. Screen names are a handy way to protect their identities to some extent.   Patients using screen names when contacting you create the potential to jeopardize the confidentiality of the communication. You may not easily recognize or associate the screen name with that particular patient. We all are warned that if we do not recognize the identity of the sender, we should delete the email to protect our computers from illegal access by cyberspace predators or to prevent the introduction of a virus. 

The likelihood is real that more than one patient may use similar screen names with slight variations (such as marathonman, marathon123man, marathonmate and so forth). Lessons learned from misadventures associated with look-alike/sound-alike drugs will encourage you to be careful with respect to look-alike/sound-alike screen names: be sure that the screen name you are responding to is the actual screen name for the patient you intend to provide with an email response. 

What if you confuse screen names with your patients’ identities and inadvertently respond to the wrong person with another patient’s confidential information? A breech of confidentiality occurs at your hand, innocent and unintentional, but a violation nonetheless.

Or consider this possible scenario, an example provided by the American Psychiatric Association (APA) Council on Psychiatry and Law on its FAQ website: Your patient sends you an email in which he describes delusions of a political nature. Given the practice of randomly scrutinizing use of the internet for purposes of national security, it is plausible that an ISP (internet security provider) might take an interest in such confidential email content from your patient to you.

Continue to pg. 2