Help Stanford Medical School teach EHR Etiquette to students

Over the weekend, I received this message from Beverley Kane, MD, who teaches in the Stanford School of Medicine (and who, along with Danny Sands, MD, developed the very very first guideline for e-mail interactions between patients and doctors). Great to see medical schools thinking of this, and I also hope they will consider teaching about how to interact with patients online, including how to write to patients (If any school teaches this now, please post in the comments), and how to share patients’ health data with them online as well.

I sent Beverley a link cloud with resources available from Kaiser Permanente which are available online.

If you have useful information for Beverley, feel free to post links in the comments, or send directly to her at bkane1[atSign]

Dear Medical and Medical Informatics Colleagues,

Our Stanford Practice of Medicine (Intro to Clinical Practice) course is introducing a segment this spring to teach med students how to maintain rapport with patients while using the electronic health record.

Do any of you, your institutions, or EHR vendors have guidelines, white papers, or teaching materials for EHR etiquette?

Thanks in advance for anything you can send us. I will be happy to share our course materials when finalized.



Beverley Kane, MD Program Director, Medicine and Horsemanship

Stanford University School of Medicine Center for Education in Family and Community Medicine

See Emmy Award-winning Stanford “Medicine & Horses” video on NBC-TV The Manual of Medicine and Horsemanship: Transforming the Doctor-Patient Relationship with Equine-Assisted Learning



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.

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,


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

Aloha, Jerry –
Mia Carson here, in Makawao…hoping to talk with you about above issues, pls respond if you see this.
Mia Carson, MD
Bridge Medicine LLC

Ted Eytan, MD