On call and online: sociohistorical, legal, and ethical implications of e-mail for the patient-physician relationship

JAMA. 1998 Oct 21;280(15):1353-9. doi: 10.1001/jama.280.15.1353.


Increased use of e-mail by physicians, patients, and other health care organizations and staff has the potential to reshape the current boundaries of relationships in medical practice. By comparing reception of e-mail technology in medical practice with its historical analogue, reception of the telephone, this article suggests that new expectations, practice standards, and potential liabilities emerge with the introduction of this new communication technology. Physicians using e-mail should be aware of these considerations and construct their e-mail communications accordingly, recognizing that e-mail may be included in the patient's medical record. Likewise, physicians should discuss the ramifications of communicating electronically with patients and obtain documented informed consent before using e-mail. Physicians must keep patient information confidential, which will require taking precautions (including encryption to prevent interception) to preserve patient information, trust, and the integrity of the patient-physician relationship.

Publication types

  • Historical Article

MeSH terms

  • Communication
  • Computer Communication Networks* / legislation & jurisprudence
  • Computer Communication Networks* / standards
  • Disclosure
  • Ethics, Medical*
  • Government Regulation
  • History, 19th Century
  • History, 20th Century
  • Informed Consent
  • Internet / history
  • Jurisprudence
  • Licensure
  • Medical Records
  • Physician-Patient Relations*
  • Policy Making
  • Practice Patterns, Physicians'* / history
  • Practice Patterns, Physicians'* / legislation & jurisprudence
  • Practice Patterns, Physicians'* / standards
  • Practice Patterns, Physicians'* / trends
  • Risk Assessment
  • Social Change
  • Telephone / history