The Future of Email In Physician Communication

Forty-five years ago, a computer engineer in Boston sent an electronic message between two computers some 10 feet apart. It was another 10 years or so before the electronic mail message was dubbed “email”—a term now perhaps more ubiquitous than any other in the lexicon of modern communication.

And yet, despite the seemingly definitive role email communication holds for otolaryngologists—in sharing messages with other physicians, sending missives to hospital administrators and instructions to patients, and myriad other uses—there are those who often wonder if email is outmoded. In a world of text

messaging, Facebook, Twitter, Skype, Snapchat, Vine, Periscope, and Google Talk, not to mention dozens of lesser-known services and a seemingly endless string of startups aiming to be the proverbial next big thing, is email dead?

In a word, no.

“But it may be dying,” said Albert Merati, MD, chief of laryngology with the University of Washington School of Medicine’s department of otolaryngology–head and neck surgery in Seattle. “Email requires a remarkable set of social norms and tacit agreements that are really lost on a lot of people. Email seems to beget more email, for better or worse.”

Physicians and communication experts interviewed by ENTtoday agree that email has a function and isn’t going anywhere anytime soon. However, that function is dependent on trust, urgency, formality, and relationships.

“Email versus texting has to do with the sensitivity and the nature of what you’re talking about,” Dr. Merati said. “There’s the immediacy, the intimacy, and the perceived security of texting, compared with email, that drives a lot of those decisions.”

Formality

Communications consultant A.J. Moore, PhD, an associate professor of journalism in the department of communication and journalism at Rider University in Lawrenceville, N.J., put it even more bluntly when he asserted that email isn’t going anywhere.

“Research shows—and I know I do it myself—the first thing I do in the morning when I pick up my phone is check my email,” he said. “People often check their email before they check the weather, before they check social media. Sure, there are other places to go; there are other ways of communicating. But I still think that email is the center point. It’s the starting line for your communication.”

The urgency that comes with a text message or a direct message on Facebook or Twitter is the flip side of the formality that comes with an email, said Dr. Moore. “Email has more of a professional connotation to it than a Facebook message,” he said. “Even if I work with somebody, even if I’m Facebook friends with somebody and that person is one door away from me, if it is a work conversation I am going to send them an email.”

Formality is the delineation between social media and what Dr. Moore half-jokingly calls “professional media.” And, while in some ways technology gaps can often be a generational difference, Dr. Moore doesn’t see email usage through that prism—certainly not when he’s interacting with the young adults in his classes.

“I look at myself as a professor, and I have that formal relationship with younger people being students, they know … they could find me on social media,” he said. “There’s nothing preventing them, but still they reach out to me via email, and I communicate with them via email.”

John Sinacori, MD, director of the Voice and Swallowing Center and an advisor to the otolaryngology residency training program at Eastern Virginia Medical School in Norfolk, agreed that the younger otolaryngologists he works with use text messaging more often than email, but these days, the use of text messaging technology isn’t divided by age groups. Dr. Sinacori answered questions for ENTtoday via text message. He said he gets between 40 and 60 texts daily, and it is often the best way to reach him, as he reviews his texts before he checks his email. “My 80-year-old mother, who doesn’t know how to use a calculator, knows how to text and really doesn’t use email,” he said. “Age is not a factor anymore.”

People often check their email before they check the weather, before they check social media. Sure, there are other places to go; there are other ways of communicating. But I still think that email is the center point. It’s the starting line for your communication. —A.J. Moore, PhD

HIPAA

Concerns about the safety of email cause many to question its fate. In a broad sense, that is the natural question asked about any new technology, said Ben Compaine, MBA, PhD, director of the Fellows Program at the Columbia University Institute for Tele-Information and a lecturer in the D’Amore-McKim School of Business at Northeastern University in Boston.

“There are always people who will find something to fear,” he said. “Like when ATMs came along, there was stuff being written about safety concerns: ‘People will go to an ATM and someone just holds them up and gets their money.’ It’s happened, but given the hundreds of millions of transactions that go on, you don’t throw out the baby with the bathwater.”

Dr. Sinacori said that when residents are communicating sensitive patient information, they know not to use text messages or other services that the hospital has not certified as compliant with the Health Insurance Portability and

Accountability Act (HIPAA). Email is also important for more formal and professional intra-department or intra-system communications.

“When residents are on call and need to schedule follow-up for certain patients, they will share that info via email since it is HIPAA compliant,” he said. In addition, “if I need to communicate with another department at our institution or at an outside institution, email would be the more professional and preferred way.”

Shiny and New

So if otolaryngologists and communications experts believe email retains a place in the way information is conveyed, why does the question of its impending death continue to be a parlor game for some?

“Because there’s always something new,” Dr. Moore said. “Because Messenger on Facebook looks a little bit flashier than email. Because now we have Periscope. Now we have Twitter. Now we have different types of platforms that message within each other. They all look flashier.”

Dr. Sinacori compared talk of the death of email to rumors regarding the death of the U.S. Postal Service, referred to as “snail mail” by most.

“If I needed a letter of recommendation [today], I would email my colleague and send an attachment with my C.V.,” he said. “I would not text them; however, I remember the day when I would have mailed—yes, with a stamp actually—a letter with [my] C.V. as a hard copy because email was less formal.”

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Richard Quinn is a freelance medical writer based in New Jersey.