Email in patient communication: three reasons against it
Email is convenient, available everywhere, and the wrong route for health data. Not because of a rule, but because of three properties built into the protocol itself.
Almost every practice has a mailbox in which patient queries accumulate. It was never set up for that, but it appears in every imprint, and anyone who finds an address writes to it.
That this is problematic is often heard; why, rarely. It comes down to three properties, and none of them can be compensated for by careful handling.
First: the transport route
An email is not delivered directly but passed along a chain of servers. Between two stations the connection is usually encrypted these days, but at each station the message sits in plain text, and who operates those stations is decided by the recipient, not the practice.
That is the difference from end-to-end encryption, where only sender and recipient can read. With email the number of parties in the know is neither known nor limitable. For health data, sensitive under Art. 5 FADP, that is the decisive weakness.
Second: identity
A sender address is not an identity. It can be forged, and even when it is genuine it only says who owns the mailbox — not who is sitting in front of it. A practice replying to a query does not know with certainty whom it is writing to.
In daily work this is solved by calling back, and that call is exactly why the supposed time saving of email often is not one: the message arrives quickly, clarifying it still takes a phone call.
Third: where it ends up
An email lands in a mailbox. The patient record is elsewhere. Between the two stands a person who reads the message, looks up the right patient and transfers the content — every time, for every message.
This is the point at which email loses not only legally but practically. What stays in the mailbox is not documented, and what is transferred costs manual work. A channel that writes straight into the record saves that step entirely rather than partly.
An email is quick to send and slow to process. The effort is not in sending but in matching.
What email is still right for
Not everything a practice sends is health data. For messages with no bearing on a treatment, email remains the simplest route, and replacing it with something more laborious would be symbolic politics.
- Appointment confirmations and reminders that do not state the reason
- Holiday closures, changed opening hours, general notices
- Invoices, as far as they contain no diagnosis
- Enquiries from companies, suppliers and job applications
The dividing line is simple: as soon as the message reveals that a particular person is being treated, or for what, it does not belong in an email. The mere fact that someone is a patient of a practice can already be information about their health — particularly clearly with a specialised practice.
What takes its place
The replacement has to do three things email cannot: encrypt throughout, identify the other side, and write back into the patient record . Everything else is equipment.
The practical stumbling block is not the technology but the imposition: a channel for which patients have to create an account and install an app will not be used by some of them, and for those the communication carries on by email. Nothing is gained. Access without installation is therefore not a convenience but the precondition for the change being complete at all.
