Miriam A. Knoll, MD, and Richard L. Bakst, MD
Mt. Sinai Medical Center
Effective communication is vital in all aspects of medicine. In today’s multidisciplinary health care setting, the many members of each patient’s health care team need to work together to deliver optimal care. The electronic medical record (commonly known as EMR) contains each patient’s medical information and their physicians’ notes for plans for care. Clinicians need quick ways to communicate with each other, especially when doctors see patients in different locations and on different days (even while practicing within the same health care system). Hospital-based email communication is a key way that doctors impart information and develop a multidisciplinary plan for their patient’s care.
It is important for trainees to learn how to compose an effective email to members of the health care team. A well-written email should convey patient information in a simple way, so that a plan can be formulated without delay. Here are some suggestions you can use when composing your emails.
SET THE STAGE
When you see a patient who requires follow-up with another physician, discuss with your attending who should be the primary communicator for the team and what mode of communication they prefer. If they task you with writing an email, we recommend the following.
Introduce yourself by name, state your job description (resident or fellow), and your relationship to the patient: “I am a Miriam Knoll, the radiation oncology resident working with Dr. Z, and we saw patient A.B. in clinic this morning.”
PRESENT THE PERTINENT DETAILS
Don’t rush composing your email. Remember to include your patient’s medical record number (MRN) and initials in the body of your email. Be sure to send a Health Insurance Portability and Accountability Act (HIPAA)-compliant email. If you are unsure what your hospital’s policies are, reach out to your hospital’s Compliance Officer for guidelines. This is especially important when you are communicating with someone who prefers to use their personal email address (such as Gmail or Yahoo) rather than a more secure hospital email address. In that case, many hospitals have a means to send secure emails and your institution’s protocol should be followed.
Explain why you are contacting this physician. Describe what is going on with your patient and include only pertinent details. For example: If the patient’s PET scan showed progression of disease throughout the lungs, liver, and spine, you may not need to include all the detailed size and maximum standardized uptake value (SUV max) measurements.
Remember, your email is not a note or a chart and therefore does not require a detailed physical exam, history, labs, imaging, and pathology report. Only include the information related to why you are communicating via email. Leave everything else to your note. Another reason not to go into too much detail is that the physician with whom you are communicating may already know the scan results. And if they have not reviewed the results yet, they will most likely view the official results themselves before writing back to you. Again, your email doesn’t replace the EMR!
Alternatively, if your concern is related to an issue such as the patient’s dyspnea on exertion, it’s best to pick up the phone and call the physician instead of emailing. Urgent clinical matters should not be conveyed via email, since you don’t want any delay in taking care of the issue at hand.
STRUCTURE YOUR WORDS, SENTENCES, AND PARAGRAPHS
Keep the email as brief as possible. Try to read your own email from your reader’s perspective. What is the shortest way to get all the important information across? If you don’t need a word or sentence, delete it. Most physicians have too many emails in their inbox, so keeping it short makes each email less of a chore to read and reply to. They will appreciate your brevity because it will relay that you really understand what’s most important to the patient’s clinical care.
To make your email more readable, separate your thoughts into paragraphs. For example, your first paragraph should be your introduction. The second paragraph should include pertinent patient information, including initials, MRN, and recent issues/complaints (the reason for your email). The third paragraph should include your suggestions, questions, and follow-up information. If necessary, break this information into a fourth paragraph. A patient issue that requires more than four paragraphs to explain would probably be best served by a direct phone call.
CLOSE WITH CLARITY
To complete your email, be specific regarding the purpose of your communication. State what your suggestion is and then ask your question clearly and directly. Include your direct follow-up plans with the patient. For example: “Mrs. Z will be seeing you next week on September 9.” Or, “I let Mrs. X know that I would check in with you and let her know what we discussed.” In this way, the physician will know the time frame and expectations for the appropriate follow-up.
Sign your email with your name and beeper/ pager number in case the physician wants to contact you for further discussion in person. If you have an official standardized email signature (which usually includes your name, title, department, and hospital), include this at the bottom of your email.
Lastly, don’t forget to copy your attending on the email as well as others on the multidisciplinary team, including nurses, therapists, residents/fellows, and outside attendings, involved in the patient’s care.
WHAT DOES AN EFFECTIVE EMAIL LOOK LIKE?
The clinical scenario: You are in the clinic with your attending, Dr. Adams. You just saw patient P.T. together and think he may benefit from palliative radiation. You and your attending need to check with the medical oncologist, Dr. Brett, about whether more chemotherapy is planned for this patient and if she agrees with the plan for radiation.
The first step is to ask your attending, Dr. Adams, if you should take the lead on contacting Dr. Brett. If he agrees that you should be the primary communicator, go ahead and compose your email. Don’t forget to copy Dr. Adams on the email as well.