TCPR: Dr. Grohol, you frequently speak on the use of e-mail in clinical practice. Can you give us some guidelines for how we should most appropriately use e-mail with our patients?
Dr. Grohol: The first thing I recommend is that physicians and therapists give a good amount of thought to their own boundaries around e-mail communication with patients. One of the crucial questions is, under what circumstances should patients e-mail you? Some clinicians limit e-mails to administrative issues, such as appointments and prescription refills. Others allow patients to ask significant questions about treatment. Another important issue is how quickly patients should expect you to respond. Many patients expect that e-mail should be responded to immediately, but that isn’t feasible in most practices. So you may adopt a policy of reading and responding to all your patient e-mail on one or two specific days per week.
TCPR: Responding to e-mail can take a lot of time. Are we allowed to charge for e-mail contact?
Dr. Grohol: Yes, you can certainly charge a fee. In fact, there is an AMA CPT code for e-mail consultation, 0074T, but most insurance companies will not reimburse for this code yet. Many practitioners set an out-of-pocket fee for e-mail contact, and this will typically be in the range of $20 to $25 per consultation. Patients are very often willing to pay this in order to have some clinical contact between face-to-face sessions. The key is to develop your own electronic communication practices, and to discuss them with your patients ahead of time.
TCPR:What can go wrong with e-mail therapy?
Dr. Grohol: The worst case scenarios have to do with confidentiality issues. Unless you use a paid service to encrypt clinical e-mail, such as Medem (see sidebar), e-mail is not secure. In many households there is only one computer, and if everybody in the family has access to it, spouses and children might read messages to and from a therapist. Some people also worry about strangers hacking in and reading confidential e-mail, but in my experience this is rarely an issue, because hackers are unlikely to spend much energy in order to read someone’s e-mail to a doctor. They’re usually trying to get into bank accounts!
Dr. Grohol is CEO, PsychCentral.com, and author, The Insider’s Guide to Mental Health Resources Online (Guilford, 2003).