Open Access Research article

Use of email in a family practice setting: opportunities and challenges in patient- and physician-initiated communication

Ayaz Virji1*, Kimberly SH Yarnall2, Katrina M Krause2, Kathryn I Pollak2, Margaret A Scannell3, Margaret Gradison2 and Truls Østbye2

Author affiliations

1 6-Step Weight Loss Center, 13191 Starkey Rd, Suite A-3, Largo, FL 33773, USA

2 Department of Community and Family Medicine, Duke University Medical Center, Box 2914 DUMC, Durham, NC 27710, USA

3 Johnston Memorial Hospital, PO Box 1376, 509 Brightleaf Boulevard, Smithfield, NC 27577, USA

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Citation and License

BMC Medicine 2006, 4:18  doi:10.1186/1741-7015-4-18

Published: 15 August 2006



Electronic mail (email) has the potential to improve communication between physicians and patients.


We conducted two research studies in a family practice setting: 1) a brief, anonymous patient survey of a convenience sample to determine the number of clinic patients receptive to communicating with their physician via email, and 2) a randomized, controlled pilot study to assess the feasibility of providing health education via email to family practice patients.


Sixty-eight percent of patients used email, and the majority of those (80%) were interested in using email to communicate with the clinic. The majority also reported that their email address changed less frequently than their home address (65%, n = 173) or telephone number (68%, n = 181). Forty-two percent were willing to pay an out-of-pocket fee to have email access to their physicians. When evaluating email initiated by the clinic, 26% of otherwise eligible patients could not participate because they lacked email access; those people were more likely to be black and to be insured through Medicaid. Twenty-four subjects agreed to participate, but one-third failed to return the required consent form by mail. All participants who received the intervention emails said they would like to receive health education emails in the future.


Our survey results show that patients are interested in email communication with the family practice clinic. Our feasibility study also illustrates important challenges in physician-initiated electronic communication. The 'digital divide' – decreased access to electronic technologies in lower income groups – is an ethical concern in the use of email for patient-physician communication.