[The electronic mail in the patient-physician relationship]

The continuous spread of e-mail determines an ever-increasing use of this tool for information exchange in healthcare. In spite of that, the frequency and quality of on-line communication between the physician and the patient are still scarce. Beyond analyzing the causes that make difficult the adoption of e-mail in healthcare, and beyond explaining the potential advantages, this paper focus on how this type of communication may influence the patient-physician relationship. More specifically two different types of patient-physician relationship have to be distinguished: type A is characterized by the absence of a preexisting face-to-face interaction, whereas type B is characterized by the presence of a preexisting contractual relationship. The management of e-mail messages needs attention and requirements that are different in the two cases. In type A relationship, there apply some principles different from the guidelines prepared by the American Medical Association that refer to type B interaction. The authors describe and comment the principles and guidelines that apply to the two types of patient-physician relationships. The aim of this work was to help physicians to manage and treat e-mail communication with the patient in a suitable way.