Hi Ted,
Just some random thoughts as i reflected on my own experience with pt e-mai...
my e-mailing patients seemed to fall into recognizable groups: "jokers", "data junkies", "just the facts", "requesters" and "why? why? why?". To keep up with the volume of e-mails, it seemed to help to provide some guidance in the way I responded to their e-mail - both in content and style. Gentle redirection, not indulging tangential comments, attaching approrpriate links or pssting patient ed material all helped streamline the work and move them from a less desirable category into a better one. There was definitely an efficiency difference compared to my colleague who valued the social interaction much more. Sometimes I would actually be concerned about not being too quick to answer to avoid unintentionally taking away the advantage of "asynchrony". and when there were 3 exchanges on the same issue, I picked up the phone.
regards, Jerry

Dear Lisa,

Great comments, and I totally agree. What I've done in the past is ask one simple question - "Do you use the internet?" (or in 2010, I might ask, "How do you use the Internet in your health and health care?") and then just listen. Very simple, very quick, and from there a physician can learn what's most important in terms of interaction.

Your comment also reminds me that patients would be great faculty in a course like this,

Ted

I am delighted that EHR etiquette is being considered, let alone taught. From personal experiences, I believe maintaining a reasonable amount of eye contact and spending enough time looking at the patient's body are the most important issue for rapport. I see this with my children's pediatricians, who type more than they look at the patients. Of course I understand the value of their typing. I know that Dr. Danny Sands talks about showing the screen to patients - this has value as well since otherwise one can easily get a paranoid sense about what is being written.

If I may add another topic, please consider the etiquette of introducing Internet use into the consultation. Given the extent to which patients look online before going to the doctor, and search immediately after, especially when given a new prescription or diagnosis, it could benefit both physicians and patients for that to be introduced by the physician. I have heard many stories about patients who test how current or thorough their doctor's knowledge is, comparing it to what they learned online, which can erode trust. Also patients who are convinced of a diagnosis obtained through the use of the Web but don't mention it to their doctor.