Doctor-Patient E-Mail Raises New Liability Issues.

DALLAS -- Think twice before clicking the "send" button when replying to an email from a patient, Todd Dicus warned at the annual meeting of the American Academy of Family Physicians.

Incomplete or incomprehensible e-mail messages can have legal consequences, said Mr. Dicus, a lawyer who serves as the AAFP's general counsel at the academy's headquarters in Leawood, Kan.

"When you're very hurried in putting together an e-mail for patients, you may be thinking in clinical terms. Your patient may not have a clue what [you're trying to say] if you start using shorthand definitions or technical terms. Look at your e-mail before it goes out to make sure your patients are likely to understand it," he advised.

Many states require medical licensure in their own state before an out-of-state physician may render care to patients electronically. Yet state medical boards have been slow to promulgate rules about physician-patient e-mail, Mr. Dicus noted.

"There are a lot of things that we just don't have the answers to right now as to what the level of liability is going to be for physicians who use e-mail," he said. "One question is, if physicians don't answer an e-mail, are they liable if the patients harm themselves because a physician didn't reply? We don't know."

Appropriate e-mail communications include prescription refills, making appointments, nonurgent medical advice, nonurgent medical follow-up, nonurgent medical correspondence, billing and insurance questions, and test results.

Inappropriate topics to discuss via e-mail include urgent medical problems, mental health issues, drug- and alcohol-related disorders, HIV and other STDs, and work-related injuries.