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Stephen M. Borowitz, MD; Jeremy C. Wyatt, MRCP, DM, FACMI

JAMA. 1998;280:1321-1324.

Context.— Despite the common use of e-mail, little beyond anecdote or impressions has been published on patient-clinician e-mail consultation.

Objective.— To report our experiences with free-of-charge e-mail consultations.

Design.— Retrospective review of all e-mail consultation requests received between November 1, 1995, and June 31, 1998.

Setting and Participants.— Consecutive e-mail consultation requests sent to the Division of Pediatric Gastroenterology at the Children's Medical Center of the University of Virginia in Charlottesville.

Main Outcome Measures.— Number of consultation requests per month, time required to respond, who initiated the request and their geographic origin, and the kind of information requested in the consultation.

Results.— During the 33-month period studied, we received 1239 requests, an average (SD) of 37.6 (15.9) each month. A total of 1001 consultation requests (81%) were initiated by parents, relatives, or guardians, 126 (10%) by physicians, and 112 (9%) by other health care professionals. Consultation requests were received from 39 states and 37 other countries. In 855 requests (69%), there was a specific question about the cause of a particular child's symptoms, diagnostic tests, and/or therapeutic interventions. In 112 (9%), the requester sought a second opinion about diagnosis or treatment for a particular child, and 272 consultations (22%) requested general information concerning a disorder, treatment, or medication without reference to a particular child. A total of 1078 requests (87%) were answered within 48 hours of the initial request. On average, reading and responding to each e-mail took slightly less than 4 minutes.

Conclusion.— E-mail provides a means for parents, guardians, and health care professionals to obtain patient and disease-specific information from selected medical consultants in a timely manner.

From the University of Virginia Health Sciences Center, Charlottesville (Dr Borowitz); and the School of Public Policy, University College London, London, England (Dr Wyatt).

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