Addressing misinterpreted emails in healthcare

“Healthcare professionals use email for a multitude of purposes: for both formal and informal communications with colleagues and patients; to perform administrative duties; to conduct routine communication; and to undertake research and improvement projects. It is also used by management at all levels to convey information to large or small groups of staff,” writes the Cambridge University. The benefits of email in healthcare include:

• “Emails are delivered almost instantaneously, at minimal or no cost to sender or recipient.
• Email can avoid the need for more time-consuming interactions such as telephone calls or face-to-face meetings.
• Digital images and documents can be transferred easily.
• Unlike a telephone conversation, email is an asynchronous method of communication as no coordination is required between participants.
• Messages can be sent and subsequently read at an opportune time, including outside of traditional office hours.
• Emails can be used as reference information for the recipient, aiding recall and providing evidence of the exchange.
• Email allows communication to large groups.
• Correspondents can be geographically distant.”

However, despite these advantages, emails are not immune to being misunderstood.

Patients frequently misunderstand physician phrases and assign opposite meanings to what was intended, leading to confusion about health outcomes, a study published in JAMA Network Open titled, “Accuracy in Patient Understanding of Common Medical Phrases” reported. Addressing these pitfalls is crucial for effective healthcare email communication.

Why misunderstandings happen in email communication

Misunderstandings in email communication can occur due to:

Lack of non-verbal cues

Unlike face-to-face interactions or even phone calls, emails do not include tone of voice, facial expressions, or gestures, cues that help clarify meaning. A sentence meant to be neutral can be read as abrupt or dismissive, especially when patients are already anxious about their health.

Use of medical jargon

Healthcare professionals are trained to use technical language to describe diagnoses, procedures, and treatments. However, this terminology can be confusing or intimidating to patients, particularly those with lower health literacy. Even common phrases like "unremarkable X-ray" or "positive result" may be misinterpreted. For instance, in lay terms, "positive" often means good, but medically it may indicate the presence of disease.

Vague or ambiguous wording

Phrases like “we’ll monitor this” or “please follow up if necessary” can confuse patients. What does "monitor" entail? Is the condition serious? Should the patient call again next week or wait for another message? Such vagueness can leave patients unsure about the appropriate next steps.

Lengthy or poorly structured emails

Emails that are too long or disorganized make it difficult to identify key messages. Without clear headings, bullet points, or summaries, important information may be missed. Patients reading on mobile devices may skim the content and miss vital details.

Cultural and language differences

Language proficiency and cultural background significantly influence how patients interpret emails. Certain phrases may carry different connotations across cultures, and idioms or metaphors can be particularly confusing for non-native English speakers.

These factors can lead to misinterpretation of the sender's intent, confusion for patients without medical background, and difficulty in identifying key points.

Impact of misinterpreted emails on healthcare

The consequences of miscommunication in healthcare email exchanges can be significant, affecting patient safety, emotional well-being, and the overall quality of care. These risks are compounded when patients misunderstand medical terminology or instructions, especially in the absence of real-time clarification:

Mismanagement of treatment

When patients misunderstand email content, such as medication dosages, test results, or follow-up instructions, they may unintentionally make harmful decisions. According to the study Electronic communication improves access, but barriers to its widespread adoption remain, even minor communication errors in electronic messaging systems can lead to clinical mistakes, including medication errors and missed diagnostic follow-ups.¹ Patients who misinterpret a physician’s message may, for instance, stop taking prescribed medication prematurely or miss time-sensitive appointments, undermining the intended treatment plan.

Example: A patient misreads “take two tablets twice daily” as “take two tablets daily,” resulting in subtherapeutic dosing and delayed recovery.

Emotional distress

Misunderstood emails can trigger unnecessary anxiety or, conversely, provide false reassurance. For example, a phrase like “positive result” may be interpreted as good news by a layperson, while in clinical terms it often signals the presence of a disease. 

Evidence: The above study, Accuracy in Patient Understanding of Common Medical Phrases, found that patients routinely misunderstand common clinical phrases, often assigning the opposite meaning. This confusion can lead to panic or, worse, delayed response to serious conditions due to underestimating the urgency of a message.

Reduced trust

Repeated miscommunications can erode patient-provider trust. When patients feel confused or misled by email communication, they may begin to doubt the competency or attentiveness of their healthcare providers. This can result in patients disengaging from care, delaying follow-ups, or seeking care elsewhere. Trust is foundational to patient adherence and satisfaction; without it, continuity of care suffers.

Evidence: A study in Patient Education and Counseling titled How does communication heal? Pathways linking clinician-patient communication to health outcomes found that patients who experienced communication breakdowns were significantly more likely to rate their healthcare providers poorly and were less inclined to follow recommended care plans.

Legal and ethical concerns

From a legal and ethical perspective, failure to communicate effectively via email can expose healthcare providers to liability. If a patient is harmed due to a misinterpreted instruction or test result conveyed via email, this could be considered a breach of the duty of care. Furthermore, according to the American Medical Association (AMA) guidelines on electronic communication, clinicians have a responsibility to ensure that electronic messages are understood and that patients are capable of following through on the advice provided. Inadequate documentation or lack of follow-up can increase legal exposure.

See also: 

• HIPAA Compliant Email: The Definitive Guide
• Choosing a communication platform for patients
  
  

Responding to a misunderstood email

If a patient misunderstands your email, address the issue promptly and clearly to ensure their understanding and maintain trust. Here’s a detailed approach:

1. Respond promptly: Address the misunderstanding immediately to prevent any further confusion or issues.
2. Acknowledge the misunderstanding: Begin your response by acknowledging that there seems to be a misunderstanding. This shows empathy and understanding of the patient’s perspective.
3. Restate the key information: Clearly restate the important information from the original email. Use simple, straightforward language to ensure clarity.
4. Provide additional explanation: If necessary, provide further explanations or break down the information into smaller, more digestible parts. Avoid medical jargon, or explain any terms that might be confusing.
5. Encourage questions: Invite the patient to ask any additional questions they might have. Encourage open communication to ensure they feel comfortable seeking further clarification.
6. Offer alternative communication methods: Sometimes, written communication can be challenging. Offer the patient the option to discuss the matter over the phone or in person.
7. Confirm understanding: Ask the patient to confirm their understanding of the clarified information. This can be done by asking them to summarize what they have understood or by asking specific questions to gauge their comprehension.
8. Document the interaction: Keep a record of the communication for your files. This can be important for future reference and continuity of care.

See also: How to balance personalization and privacy for HIPAA compliance

FAQs

What are the common things that patients misunderstand in email communication?

Patients often misunderstand the following in email communication:

• Medical terminology
• Instructions for procedures
• Appointment details.
• Medication instructions
• Health condition explanations
• Follow-up steps
• Insurance and billing information
• Results interpretation

Why is it important to acknowledge a patient’s confusion in your response?

Acknowledging a patient's confusion shows empathy and validates their feelings, which helps build trust and rapport. It reassures the patient that their concerns are being taken seriously.

What role does empathy play in effective email communication with patients?

Empathy helps build trust and rapport by demonstrating an understanding of the patient’s perspective and emotions. It creates a supportive environment where patients feel heard and respected, enhancing their overall experience and satisfaction with care.