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E-mail etiquette


You can leave a trail of irritation behind you and never know it, if you're unaware of these rules of Internet courtesy.


E-mail etiquette

You can leave a trail of irritation behind you and never know it, if you're unaware of these rules of Internet courtesy.

By Gilbert L. Solomon, MD
Family Physician/Malibu, CA

While opening my e-mail one evening, I was taken aback by a flash of hostility on my screen. In all caps and a take-no-prisoners font, the message practically screamed: "TAKE ME OFF YOUR MAILING LIST IMMEDIATELY. I AM NOT INTERESTED!" Apparently, the e-mail newsletter I'd sent to the FP residents where I teach had elicited more reaction than I'd bargained for.

I quickly figured out why. In my latest edition, I'd included a petition soliciting support for a well-known artistic organization that, though highly respected, had a sometimes controversial history.

If I'd been mailing a printed letter to those residents, I undoubtedly would have realized that such a petition has no place in a professional communication among physicians. But between point and click, it often seems there's just a nanosecond. So, without reflection, I'd sent that petition to several dozen people whose personal beliefs I didn't know and had no right to make assumptions about.

As the saying goes, new technology lets us make more and faster mistakes. With the Internet, we can also disseminate them widely. Since that particular snafu, though, I've become more aware of e-mail do's and don'ts. Here's what I've learned about what technology journalists have dubbed "netiquette":

• Practice truth in labeling. Many people get scores of e-mails daily. So even when messages don't need an "urgent" notice in the subject line, it's considerate to use that area to clearly state your topic. I may write "Draft of article attached" or "Have to cancel tomorrow's meeting." These phrases help recipients prioritize which messages to read first. The second example helps even more, by including the gist of the message.

But don't stop there. When you reply to an e-mail, by default the software generally keeps the same "subject" phrase (maybe preceding it with "Re:" or some other prefix) as you and your correspondent create a thread of linked messages. If that thread changes, so should the phrase. For example, if a "draft attached" message elicits a reply that turns into a discussion of where to meet for lunch, I change the subject to something like "How about Joe's Diner?" Otherwise, keeping track can be confusing—especially if such messages start to involve other people.

• Watch your tone. For 70 years, my father-in-law and his two best friends kept their childhood friendship strong despite geographic distances, through phone calls, letters, and visits. It took the miracle of e-mail to separate them. At first, the messages helped maintain their bond. Soon, though, two of them got into an e-quarrel over politics—and stopped communicating.

That fight arose, ironically, from what can be a great feature of e-mail: rapid conversational interchanges. But even though you type the talk, you can't type the walk. When we speak on the phone, our tone and vocal rhythms let the listener know whether we're joking, puzzled, or insulted. In person, so do our facial expressions and body language. Without those guides, the potential for serious miscommunication exists.

I've experienced that myself; at times, correspondents have taken my messages the wrong way. For instance, suppose a colleague or student sends me a paper to evaluate, and I write, "Wow! I guess you really knocked yourself out on this one." Some people might read those words as sarcastic. Yes, casual language is appealing, but it's also more likely to be misinterpreted than formal diction.

Doctors in particular should avoid what could seem flippant or even insulting, especially concerning professional matters. You can still sound friendly and informal, while being simple and straightforward. For example: "I can see you put a lot of effort into this report. It's excellent work." So, except for people you keep in touch with very closely, use informal language and humor cautiously, and skip sarcasm completely.

• Learn the language. Because typed words can be so misleading about your intentions, e-mail users have developed acronyms and symbols to help fill things in. So, for instance, I could type "LOL" (laughing out loud) to indicate I'm joking, or "IMO" to show that my argument is only "In My Opinion." Sometimes I even write "I'm just kidding," in parentheses. A little clunky, but certainly clear.

Similarly, I might use an "emoticon," which is a kind of cyberglyphic—a combination of keyboard symbols that by convention represents a certain facial expression. A sideways smile, made with a colon followed by a close-parentheses, indicates a light tone. And I never use all upper-case—which, as the FP resident's reaction to my newsletter reminded me, is considered shouting.

• Skip the jokes and other junk. My wife once sent some friends a page of anecdotes, including the kind whose punch lines tend to equate the legal profession with roadkill. Sure enough, one attorney in her circle let her know that he was seriously offended. You can't assume people share your sense of humor, especially when they're the target of the joke.

Joke mail is really a kind of junk mail, and to some people it's irritating. Before telling an anecdote to a colleague in person, you instinctively get a fix on the prevailing emotional climate. But you can't tell what mood your e-mail will sail into. Even with friends, ask whether they want to receive jokes—and always avoid passing on potentially offensive humor.

Jokes aren't the only junk to avoid. My 11-year-old daughter recently passed along an e-mail to me about a spider that purportedly infests restroom toilet seats and may bite women on the buttocks, sometimes fatally. Hmmm. The spider's name was given as Araneida gluteus. Well, maybe a medical student started this one. Okay, I chuckled for a second—but that was a kid sending to her dad. As a grownup, you probably know that the Internet has a whole Sargasso Sea of garbage, gossip, nonsense, and rumors floating through it. Avoid spreading this stuff. Most people have enough real messages to deal with.

A simple rule: If you wouldn't drop into someone's office to convey the message, don't interrupt with it electronically.

• Allow for the download factor. You can waste people's time quite unintentionally, too. If your message contains a complex graphic or a long file to be downloaded, make sure it will be worth the wait. Maybe your Internet connection lets you download a whole tsunami of bytes in a flash, but most people's connections often work more like an IV drip tube. So unless you've checked with recipients about this sort of thing, you're generally better off not e-mailing graphics that may take minutes to coalesce on a screen, or lengthy files that may ooze interminably onto a hard disc.

• Take out the garbage. How's this for fascinating reading?

Return - Path: <John.Doe @> Received:from dy_ybOl (rly_ybOl.mail .aol .com[]) by air_yb04 with ESMTP; Thu, 09 Dec 1999 10:15:38 - 0500

Many messages acquire that kind of "header," showing their path through the Internet. I've sometimes paged through several screens of such sludge, only to arrive at a two-line joke. It's like cracking a coconut shell to find a peanut. The hunt is annoying, even when the message is important.

Do recipients a favor: Perform a garbage-ectomy. Sometimes, software hands you the scalpel. America Online lets me select only the text I want before clicking on the "forward" command. With a less helpful mail service, though, I'll clean up the message myself, or simply cut and paste to create a new one.

Another form of garbage can result when you and one or more correspondents keep batting the same message around. When you reply to a message, most e-mail software lets you "quote" what was sent to you, to help keep track of a discussion; some software does that automatically. Each line of such quoted material may be specially formatted, with a ">" symbol, or just indented. Still, messages soon become unwieldy if quoting continues unchecked. So learn how your service handles quoting, and get rid of it when it isn't needed.

Sometimes, though, quoting can be useful. If someone sends you a message with several questions, for example, it may help to reply to each with an inserted answer. Like this:

From: Gil S.

To: Bill G.

Bill, thanks for your questions. You'll find my replies below.

>Did you get my offer of $3 billion for your medical software idea?

Yes, I did.

>Did you want more? Name your price.

Yes. About $7 billion more.

>Also, please tell me any further requirements you have.

A chateau in southern France.


>Bill Gates


Gil Solomon

• Don't e-mail when you're annoyed. Just as it's not a great idea to grocery shop when you're hungry, it's best not to e-mail when you're angry. Words that have been steamed over a hot collar shouldn't be fired off while still warm; such ballistic missives have exploded friendships.

When I'm writing about something that angers me, I'll save the message and reread it before sending it, hours or even a day later. I also ask myself: What if I had to say this to the person, face to face? If that seems daunting, then chickening out may be smart. Remember, too, that the message may be stored digitally forever. The last thing you need is to have your every eruption available to future historians (and libel attorneys).

• When in doubt, print it. With snail mail, I suspect, most of us quickly review our prose before sealing an envelope, to make sure a letter really says what we mean. Unfortunately, with e-mail's faster rhythm—scan message, type reply, point, click, done!—it's easy to skip that rereading, and there's no stroll to the mailbox to allow second thoughts, either.

Moreover, e-mail is much more likely to make its way to people whose sense of humor and sensitivities you don't know; your prose might be forwarded, and forwarded again. Couple this with e-mail's instant-response capability, and it's all too easy to send a cyber-boomerang.

For these reasons, I read my e-mails carefully before sending them. I even review hard copies of any that might be misinterpreted. Sentences that look fine on screen can reveal unintended meanings on paper.

• Develop a sense of electronic timing. With other forms of instant communication—voice mail, faxes—it's generally understood that urgent matters should get a reply within hours, and other messages on the same day or the following business day. But with e-mail, apparently the rules haven't solidified yet. Some people read theirs many times a day, some do so only in the evening, and some don't even log in daily, especially over the weekend. Also, due to electronic glitches, some e-mail just disappears into the great bit-bucket in the sky.

So don't get irritated if your message isn't answered for a while. Instead, try to learn your correspondents' e-mail habits, and allow for them. As a corollary, don't rely on e-mail for urgent situations. If I do have to use it for a matter that's critical or time-sensitive, I make that clear in the subject heading (as in "URGENT—lunch today canceled"), and in the text I request an immediate reply. Then, if I don't get one, I follow up with a phone call. The point is, I keep the burden on me.

These suggestions may help you avoid some cyber gaffes and goofs. They boil down to a simple golden rule, not unlike one you already know: Send unto others as you'd have others send unto you.

Editor's Note: This story covers many aspects of e-mail, but not the special concerns that arise when communicating with patients. For more on that, see "Secure messaging: Much more than e-mail," Nov. 20, 2000, and "Save time and please patients with e-mail," July 12, 1999. Future coverage will include liability risks associated with doctor-patient electronic communications.


Gil Solomon. E-mail etiquette. Medical Economics 2001;8:61.

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