Half of veterinarians use e-mail for professional purposes, according to the 2005 AVMA-Pfizer Business Practices Study.
What the study doesn't say is how many practitioners use e-mail to communicate with their clients—or whether they should.
Apart from the few studies touching on the topic, some practitioners say e-mail is convenient for them and their clients. They add that the Internet offers other valuable avenues for communication, particularly for clinics with Web sites.
And almost half of veterinarians work at a clinic with a Web site, according to the AVMA-Pfizer study. But many, if not most, practitioners still prefer to communicate with individual clients either in person or by phone rather than by e-mail.
The pros of e-mail
Dr. Stephen Pittenger, a past president of the Association for Veterinary Informatics, was an early adopter of e-mail in practice. He works at Memorial-610 Hospital for Animals in Houston, which created a Web site and began communicating with clients by e-mail in 1995.
"Not many people had e-mail at home, but they did at the office more and more," Dr. Pittenger said. So, the practice simply printed its e-mail address on its business cards.
And after the practice began keeping electronic records in 1999, Dr. Pittenger said, e-mail became easier than voice mail to add to medical records—though voice mail does allow him to hear a client's inflections and tone.
Dr. Pittenger said most of his e-mail communication is with clients, and the practice never offers specific medical advice to nonclients. The practice rarely charges clients extra for e-mail or phone communication.
"Clients will ask just about anything via e-mail that they will over the phone," he said. "They also give us progress reports on their animals. It seems to work great for them, as they can report things at 11:30 p.m. and it is there for us to read in the morning to follow up on."
Dr. Pittenger often sends handouts, forms, or treatment plans to clients by e-mail. However, clients usually call to schedule appointments.
E-mail plus the Web
Dr. Carl Palazzolo of Long Beach Animal Hospital in California has been reaching clients by e-mail and through the hospital's Web site since 1998. He said the site receives more than 5 million hits every month, mostly because it provides details about animal diseases.
"So a large segment of the e-mail we get is actually not from my clients," he said.
Dr. Palazzolo said he has received a lot of unique questions by e-mail as well as requests for a free second opinion, or even a diagnosis. In rare cases, the hospital has helped someone overseas who found the Web site—by analyzing a bladder stone from a dog in South Korea or advising someone in Saudi Arabia who couldn't find veterinary care for a ferret. However, the hospital won't offer out-of-state consultations.
Many clients and nonclients are simply seeking general information. The topics of e-mail include boarding, refills, vaccinations, updates, and follow-up questions.
Dr. Palazzolo, who has written about organizational management for the JAVMA, suggests that veterinarians should delegate someone to answer e-mail.
"I still think it's well worth doing," he said. "We're trying to give clients the service they need. ... Everyone has their way of communicating."
Dr. Palazzolo said sometimes a veterinarian can overwhelm the client's ability to absorb information during a visit. His hospital's Web site helps clients digest the details, and computers are actually available for clients in every examination room for general information about diseases and the hospital.
"Their understanding goes up dramatically," he said. "It's a huge client tool to communicate the medical problems their pets have."
Dr. Palazzolo said the Web site also serves as a good way for the hospital to bond with existing clients and attract new ones. For example, he posts photos of new clients with their pets, with permission, and he maintains a section about the staff's adventures.
E-mail, Web services
Dr. Peter S. Glassman, director of Friendship Hospital for Animals in Washington, D.C., started using e-mail plus the Web in his practice in 2002.
"We did it because we realized it was a very efficient way of communicating, educating, building our relationships with our clients," he said.
Dr. Glassman is also president of VetInsite, which provides Web and e-mail services for veterinarians. His hospital has been the test site for the business model.
"In order to use e-mail effectively, it has to be managed," Dr. Pittenger said.
He said veterinarians need a system that allows clients to create accounts with the Web site and that handles bad e-mail addresses. VetInsite collects client e-mail addresses and then creates pet portals, or individual Web pages.
The system e-mails clients about the portals and provides passwords. The clients visit the veterinarian's Web site to log in to their pet portals, which display their pets' health information. The portals list information about individual prescriptions, food purchases, and veterinarian visits—as well as general medical topics.
Clients can fill out forms, update addresses, request refills, and e-mail the office through the pet portals.
"In general, the questions are the same questions that arise by the telephone," Dr. Glassman said. "It's really just another way for them to connect with the hospital."
He warned that veterinarians should be judicious with any advice by e-mail because a message can go to millions of people at the touch of the button. He added that each message from the hospital includes a notice to call in an emergency.
Nevertheless, he said, e-mail can be convenient for both sender and receiver for matters of less urgency or delicacy. And e-mail allows the hospital to reach out to clients with appointment reminders or electronic newsletters on medical topics.
E-mail cons and caveats
Yet even veterinarians who are comfortable with the Internet have hesitated to embrace e-mail as a way to communicate with clients.
Dr. Kevin Dajka, a 2003 graduate of the University of Illinois, said he doesn't know of any classmates who e-mail clients.
"Answering basic questions via e-mail or using it as a follow-up tool may save a veterinary practitioner some time," said Dr. Dajka, who is now assistant director of AVMA Membership and Field Services. "However, communicating complicated medical information to owners of patients is a very difficult art to master."
Trust representatives with the AVMA PLIT, which offers professional liability and business insurance, agreed on the need to establish a veterinarian-client-patient relationship before beginning e-mail communication.
"My thought is that the same advice applies whether the communication is by phone or by e-mail," said Mike Ahlert, executive vice president of Hub International, PLIT's broker. "Making a diagnosis without seeing the animal is always a risky thing and should be avoided."
Dr. Richard E. Shirbroun, Trust representative, also had concerns that e-mail might lead to making a diagnosis without a complete medical examination or to making recommendations on therapy without a diagnosis. Dr. Linda J. Ellis, Trust representative, emphasized that a veterinarian should always examine the animal.
Dr. Rodney G. Johnson, Trust representative, suggested that appropriate e-mail should become a bona fide part of the medical record. Ahlert said the legal system treats e-mail the same way as any other document.
The Trust representatives also suggested adding a disclaimer to e-mail on general topics similar to disclaimers for call-in radio shows or newspaper advice columns.
Ahlert added that state licenses vary on allowing a veterinarian to consult with a client in a state where the veterinarian doesn't hold a license.
Of course, veterinarians aren't the only doctors trying to decide how to communicate with clients by e-mail-or whether they should.
The American Medical Association has established guidelines for patient-physician electronic mail, as well as policies on other aspects of Internet communication. The guidelines are available by searching AMA's Policy Finder at www.ama-assn.org, under AMA Agenda, Be informed.