E-mail Etiquette for Your Medical Practice Staff

Most people know it only takes a few seconds to make an impression, and most first impressions are difficult to change. What most people may not realize is that this rule doesn't just apply to person-to-person meetings.

"We are in the age of computers, and e-mail is a huge way of communication, so that could be the first way of meeting a patient," says Hendersonville, N.C.-based Darlene Das, president of etiquette consulting company Today's Etiquette, and a trained surgical technician who specializes in medical practice etiquette.

When it comes to communicating with patients, and even with fellow staff, making a good impression is just the first of many reasons your written - or typed - words are so important. Come across as too cutesy, grammatically inept, impolite, or inappropriate, and your e-mails could offend colleagues or turn off patients from your practice.

Whether communicating with colleagues or patients face-to-face or via e-mail, the same age-old etiquette rules apply. You need to be polite, professional, and friendly. But because of electronic communication's unique qualities, there are additional considerations, from using proper grammar to observing formalities.

Here, we go over some basic rules of e-mail etiquette to share with your staff for office-based and patient communications.

Challenges and considerations

When you meet someone in person, you make judgments not only based on what the individual is wearing, but on how he comes across - including his facial expression. Conveying a positive, professional message, therefore, can be tough over an electronic medium.

"E-mail can also be perceived as very impersonal," says Karen Hickman, an etiquette consultant with Fort Wayne, Ind.-based etiquette consulting firm Professional Courtesy, LLC, who works with medical practices. "Especially in healthcare when you're dealing with patients, there might be some issues that you wouldn't want to discuss via e-mail that would be better to discuss on the telephone, or in person."

Also, sometimes using e-mail in lieu of a phone call can be perceived as unprofessional. For example, your staff may not be well-versed in grammar or they may not know how to convey things in writing with the appropriate tone.

"For some people, [e-mail] can seem very abrupt," says Hickman.

The biggest challenge to e-mail, though, is that it's not private. Staff may forget this when sending inappropriate jokes to each other. Or, if your staff is sending messages to patients without using a secure patient portal, it could put your practice at risk for a security breach, and penalties under the HIPAA Security Rule. [For more on e-mail privacy considerations, see http://bit.ly/MD-Email-privacy].

Rules for interoffice e-mail

Whether you're e-mailing your colleagues or patients, certain etiquette rules always apply. Grammar, punctuation, and spelling are important (be sure to avoid abbreviations such as "lol" for "laugh out loud"), and e-mails should be as brief as possible, with specific subject lines.

But don't sacrifice brevity for warmth.

"Start with a warm greeting like 'good morning' or 'good afternoon,'" says Hickman. "And then close your e-mail with a warmer feel, like 'kind regards,' or 'best regards' at the end."

With interoffice e-mails, the tone can be less formal - you can refer to someone as "Nancy" instead of "Mrs. Brown" or "Dr. Brown" - but you still have to watch what you write.

"You have to be careful that it doesn't get sloppy because this also becomes a permanent record for the company," says Hickman. "Some of these e-mails can be read in court some day. You can [take a] more informal tone with each other, but there still needs to be a sense of professionalism about it."

Examples of unprofessionalism include forwarding junk mail, chain letters, or inappropriate jokes.

"If those jokes are perceived as a racial slur, or can be considered something that is sexual and inappropriate, companies have been sued over those before," says Hickman. "These things can come back to haunt people and become a real liability."

In essence, staff should be clear that e-mail at work is only for work purposes.

"This isn't a person's mailbox at home," says etiquette expert Elizabeth MacDonald, president of The Verbal Edge, a firm that works with corporate clients to improve etiquette skills, in Fort Wayne, Ind. "This is company property."

To keep your coworkers happy, be judicious about who you include in an e-mail.

"I've seen lot of 'reply all' when all don't need the reply," says Das. "And that can be a real annoyance, I think. Be attentive that you're not so quick with that 'reply all.'"

And to avoid miscommunication, or missed messages, make sure each e-mail covers just one topic, unless otherwise noted in the subject line.

For example, if you put a note about an "executive lunch" at the bottom of the body of an e-mail message that was sent with a subject line related to a vacation day, the e-mail recipient might not scroll down and see it, says MacDonald.

E-mailing patients

Practice staff might not care when you misspell the name of a disease or insert smiley face emoticons at the end of sentences, but patients will likely be turned off by these gestures. And since an increasing amount of first-time communication with patients happens over e-mail - which should be encrypted or sent through a secure patient portal, per HIPAA requirements - staff should take extra care when writing to patients.

On initial contact by e-mail, patients should be addressed with their first and last names, or by a title such as "Mr." or "Ms." preceding their last names.

"It's important to err on the side of formality," says Hickman. "You can always go down from there. The patient can direct you on how they want to be addressed. A lot of mature people are very offended when the 21-year-old says 'Hey Matt' or 'Hey Karen.'"

Staff should take more time to proofread e-mails to patients - reading each e-mail at least once before sending to improve the likelihood of catching grammar errors. While a misplaced apostrophe or unnecessary commas are forgivable, misspelled words (especially names) and use of slang can be seen as highly offensive and unprofessional, says Das.

"Excess of exclamation points and [punctuation] marks is also not really professional," she says. "We do that, perhaps, when we're communicating with our family and friends, and that's OK there. But in a business setting, exclamation points are rarely used."

MacDonald says managers should consider giving prospective staff a grammar test before hiring them.

"I see the same mistakes constantly," says MacDonald, adding that the biggest offenders include using "your" instead of "you're," or "it's" instead of "its," or using plural and singular tenses in the same sentence. "Many people who need grammar help pluralize by adding an apostrophe and an s, or don't capitalize their proper nouns."

Improving staff e-mail today

Want to help staff improve e-mail etiquette overnight? Here are four tips for instantly improving staff e-mail:

• Go over common grammar errors. Members of your staff may not be as fluent in proper grammar as an English teacher or a journalist, but they should be familiar with basic rules such as whether to use "your" or "you're" in a sentence. "What I would suggest is bringing an expert in and creating a quiz," says MacDonald.

• Be careful with big terms. Not every patient is in healthcare, so if you're sending a patient a message, using complex medical language or short abbreviations could confuse them, says MacDonald.

• Avoid ALL CAPS. This well-known rule bears repeating, as writing in ALL CAPS comes across as screaming to the e-mail recipient and is therefore a no-no, says Hickman.

• Space correctly. E-mail paragraphs should be one to three sentences max, so as not to overwhelm the recipient. "Some people are unclear as to when to start another paragraph, so they make the whole e-mail one giant paragraph," says MacDonald. "If it's a long paragraph, I won't read the e-mail. That says, 'This person doesn't understand basic writing and English.'"

Above all else, make sure to treat your e-mail recipients with the same courtesies you're offering to someone with whom you're trying to make a great impression.

"Always use 'please' and 'thank you,' it always goes a long way," says Das. "And don't forget to praise when it's deserved, because praise can be better than a raise."

Marisa Torrieri is an associate editor at Physicians Practice. She can be reached at marisa.torrieri@ubm.com.

This article originally appeared in the October 2013 issue of Physicians Practice.