Review article
The ethics of e-mail communication in psychiatry

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Mechanics of E-mail

Many psychiatrists are unaware of the elaborate nature of Internet communication. They work under the assumption that communication goes directly from one computer to another, like a phone call; however, E-mail does not work this way. If long distance calling were analogous to E-mail, the caller would dial a phone number and tell the operator that he or she was trying to contact a particular individual. The operator would then transfer the call to another operator, followed by several more

Ethical concerns

The authors have identified three major ethical concerns for the psychiatrist who uses E-mail as part of routine practice: (1) problems inherent in the mechanics of E-mail, (2) privacy and confidentiality issues, and (3) the loss of essential elements of the therapeutic action associated with the psychiatrist–patient relationship.

E-mail requires an action on the part of the recipient. Programs must be opened, passwords entered, “junk” E-mail culled through—all of which is potentially

Comparison of electronic communication to existing means of communication

Direct doctor–patient communication at all times has not been possible in medicine in any era. Some form of intermediate information exchange has always been a part of practice. Most commonly, we depend on secretaries or nursing staff to convey messages. In these instances, the individual answering the phone, although not the therapist, is able to make some sort of assessment of the caller's need. A secretary reporting, “Mr. A said it was an emergency,” or, “Mrs. B was crying so hard I couldn't

Potential value of electronic communication in psychiatry

The authors have covered many of the pitfalls and shortcomings of electronic communication in psychiatry. The authors believe, however, that there are certain situations where this means of communication may be valuable. For example, when a therapist is out of the office for a period of time on a vacation or at a meeting, E-mail may provide a form of accessibility that is necessary for a patient with impaired object constancy. Even a brief E-mail message from a therapist can serve as a

Recommendations for the use of E-mail in psychotherapy

The AMA issued guidelines [3] regarding the use of E-mail by physicians. The AMA recommended that E-mail be handled according to a specific protocol within an office. A designated person, for example, should check E-mail at a specific time of the day. In addition, a reasonable expectation for response time should be established and enforced. Patients should be instructed on topics considered appropriate for E-mail, possibly including refill requests, appointment confirmation, scheduling

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