A proposed solution for addressing the challenge of patient cries for help through an analysis of unsolicited electronic mail

Background. Unsolicited electronic mail (e-mail) is e-mail sent to a physician from a person unknown to the physician, who is seeking professional help. The purpose of this project was to analyze unsolicited e-mails sent to a digital textbook author to: 1) characterize the e-mails, 2) determine what resources would be necessary to answer the e-mails, and 3) propose a standard approach to reply to e-mails in a helpful yet medicolegally-responsive manner. Materials and Methods. All e-mails (315) sent to a digital textbook author from October 1995 through October 1998 were abstracted. Variables included: date and location, sender type, patient age, subject, medical content, and resources necessary to answer the question. Data frequencies were obtained. Results. The most common location was the .com domain (47.6%). The most common senders were laypersons (66%). Overall, 44.4% of the e-mails concerned children. Detailed, patient-specific information was sent in 63.2% of the e-mails. The most common subjects were overviews of a disease or problem (32.4%), differential diagnosis (16.8%), and therapy/treatment questions (15.9%). The medical content covered a broad range of specialties. Specialists were overwhelmingly the resource necessary to answer the e-mails (74.9%). Conclusions. Pediatricians with educational information on the Internet can expect an increase in the number of unsolicited e-mails as Internet usage expands. Laypersons regard even short passages to mean the author is an expert in that particular area. Pediatricians need to consider the ethical and medicolegal implications of responding to unsolicited e-mails. A nonpersonalized, standard e-mail reply is proposed that directs the sender to quality information resources that may be of further assistance.