Building Your Practice
With the Internet
A Three-Part Series on the
Internet for Physicians

Part II: E-mail, FTP, Gopher, and Telnet

• Demonstrate the ways in which e-mail can benefit you in your practice and professional life
• Review basic e-mail etiquette and functionality
• Introduce the concepts of discussion and newsgroups
• Provide an overview on the use of other Internet tools, including file transfer protocol (FTP), Gopher, and Telnet

II. Brief history of the Internet

• 1960s: The Internet was developed as a response to the Cold War and the need for a reliable, independent communication system in the event of nuclear disaster.
• The Internet was designed as a very decentralized system with very few controls.
• 1990s: While formerly the province of the military and later the academic community, with the introduction of browser software for use with the web, the Internet has been opened up to the world.
• E-mail was and still is one of the Internet’s most popular applications.
• The Internet and e-mail was used by Iraq in the Persian Gulf War when its communication systems were disabled by allied forces.
• The Internet is a huge network of computer networks throughout the world. As of 9/97, there were 19,540,000 computer hosts. As of 11/95, there were between 20 to 30,000,000 users from 239 countries.
• Growing exponentially, the Internet is doubling in size every 11.1 months.

• Nearly instanteous connections between people throughout the world.
• Messages can be accessed and handled at your convenience, 7 days a week, 24 hours a day.
• Provides a written, editable record of professional exchanges or patient-to-physician communication. Files of either word processed documents or other applications (including sound, images, and video) can be attached easily.
• Can be very cost-effective, especially for communication between geographically diverse areas.
• Asynchronous communication
• An excellent free e-mail software package can be found at http:///www.eudora.com
• E-mail messages are easy to transport, to reply, to search, and to send multiple copies of
• Some people feel less inhibited in sharing their thoughts in an e-mail message

IV. Creating an E-mail message

• All e-mail messages need the following two components: an address to send the message to and the body of the message.
• Well-formatted e-mail messages that follow general e-mail etiquette also have a descriptive subject line and a signature block that includes identification of the sender.

• On occasion you cannot reply to the sender of an e-mail message. It may be necessary to address a new e-mail message, instead of replying automatically to the sender of the message.

Anatomy of an e-mail address:
UserID@Machine.subnet.net.domain
Name@StreetAddress.City.State.Country

Examples of e-mail addresses:
Kleeberg@toybox.allina.com
Paul@GAC.edu
Paul@FPEN.org
75241.117@CompuServe.com

• Providing a subject line will allow for easier searching through large volumes of messages, both through incoming new messages and through archives or folders of old messages.
• Addressing e-mail messages to a group will increase the probability that the appropriate recipient will read the message.
• Be careful to distinguish between similar-looking characters, such as the letter O and the numeral 0, the letter l and the numeral 1, etc. It is probably best to copy-and-paste addresses from another message, not to retype them, if at all possible.
• Be concise and be gentle in the body of your e-mail message. Be aware of tone, the sensitivity of the topic, and to whom you are sending the message.
• When replying to a message, copy a portion of the message to which you are responding.
• Include a personalized signature file, indicating to the reader who you are and what methods they can use to get in touch with you. Be concise.
• Reread the message text and doublecheck the recipient(s) addresses in both the To: and cc: fields.

• Address books can be set up to save e-mail addresses for individuals. Groups, representing collections of addresses, can be set up to send e-mail messages to committee members or other special populations.

• Mail filters can be set up to sort incoming mail according to defined parameters, such as the sender’s address or the type of message (i.e., Error messages). This can help with e-mail message maintenance, especially if you subscribe to numerous groups.

• Newsgroups are forums for discussing a particular topic; like e-mail they link individuals from around the world.
• One can participate actively or listen or "lurk" passively.
• Threads, or series of messages focusing on a particular topic, are easy to follow. The difference with discussion groups are that messages from discussion groups come in chronologically.
• Messages are stored on a server (another computer) and the reader chooses when he/she will access selected groups of interest.
• Newsgroups create a "public square" atmosphere rather than the "living room" atmosphere of discussion groups
• The names of newsgroups are organized according to an established convention.

VII. Discussion groups

• Discussion groups or listservs differ from newsgroups in that one must subscribe to each list and then messages from individual postings are delivered directly to a subscriber’s e-mail box.
• Discussion groups can be used to continue discussion after a conference or continue the work of a committee between meetings.
• Like newsgroups they consist of "threads" or postings discussing particular topics, but they arrive chronologically as they are individually sent. Because they are delivered directly to an e-mail box, they create a "living room atmosphere" for communication.
• Some groups are moderated by a list manager who screens postings to make sure they are appropriate for the designated topic before forwarding to the entire list; many groups are not. Subscribing to moderated lists can greatly enhance the relevance of the list and cut down on e-mail "noise" or crazy postings.
• Some groups have restricted subscriptions to only a select group, such as users of a particular product or members of a particular medical specialty; most groups are not restricted.
• Fam-Med is an example of a list discussing issues involving the utilization of computer and telecommunication technology in the teaching and practice of family medicine.
• As of 9/96 this list had 1,020 subscribers from around the world.
• Messages from lists can delivered one-by-one to the subscribers e-mail, as they come across the network, or they can be delivered in digest format (collected in one large message) once a day.
• Like the use of the Internet in general, discussion groups have greatly increased in number: as of 9/93 there were over 2,300 topical lists; in 8/94 the number was closer to 5,300; 12,850 by 11/95; 66,692 by 9/96. Today there are likely many more lists in existence, with more starting up all the time.
• There are web sites that provide databases of discussion groups

• The Medical Matrix mega-site (http://www.medmatrix.org) also provides links to forums on nearly every medical specialty.
• Discussion groups are typically subscribed to by sending an e-mail with the following message "Subscribe <name of list> <your name> to the discussion group’s administration address
• The two types of addresses associated with discussion groups are important to keep straight. They are as follows:

Administration address (used for subscribing, unsubscribing, other automated requests to the computer on which the discussion list resides):

• DO NOT send requests to sign off from a list to the discussion group members address. Doing so may result in "flames" or nasty replies from other members.
• Some discussion groups are VERY active and you will receive a high volume of messages each day. Consider a moderated list to cut down on e-mail noise. Also consider reading a list as a newsgroup (some are available in each format).

• Beware of strong emotions.
• Always include a signature for people to contact you.
• Copy the essence of a message when replying, not necessarily the entire message.
• Send a gentle reminder or resend the message if you have not heard back. E-mails can get lost on the Internet.
• Keep your posting to a discussion group relevant to the topic of the list.
• Never use all caps in a message; it is considered to be the equivalent of shouting on the Internet
• You can be informative, but be careful not to advertise a particular position or product.
• If you are asked to talk about a commercial interest of yours, be sure to remove all advertising hype and testimonials, and be concise.
• And most important of all, check who you have addressed your e-mail message to before sending it. We’ve all been embarrassed by sending a message to someone we didn’t mean to include.

• FTP or file transfer protocol is an Internet protocol that allows the user to copy a file from any Internet host to another Internet host (usually your computer).
• Netscape and Explorer have their own FTP and Gopher packages built right into them. There are also dedicated FTP/Gopher packages still available as well.
• Large documents and software are sometimes made available for downloading on FTP sites. You can find free software for your personal computer (called freeware or shareware), demos of products you may be considering for purchase, and updates for commerical software you have already purchased.
• There are medical software archives available.

• Gopher was an early tool that preceded the World Wide Web. It was the first protocol to allow users to see what was in remote files. Simply put, a Gopher site on a remote computer organizes the files on that site in a hierarchical format, which can then be searched or opened directly by pointing-and-clicking.

• Gopher sites can facilitate textword searches of resouces
• They are easily customized to create a menu of links to distant resources
• Gopher remains the fastest method for publishing, storing, and retrieving text resources.
• There were over 5,900 Gopher servers as of 8/95.

• Another Internet tool that allows you to connect to a remote computer and use it as if you were sitting right in front of it.
• It is useful for applications that require super-computer power or enormous databases.
• It is also commonly used to allow physicians to login to hospital systems from home.

XII. Security issues

• Caution should be used when downloading files from remote sites, especially with FTP. Any file you retrieve from another computer may contain a virus. This can also be true with attachments to e-mail. The best practice to follow is to be familiar with the source of the files and only use those from reputable sources.
• The decentralized nature of the Internet itself, and the circuitous route that a typical e-mail message will follow, means that most e-mails should be considered a public communication. System administrators have access to incoming and outgoing messages. You also must be aware that e-mails can be easily forwarded by recipients. Secure e-mail is possible using encryption technology where the sender and the receiver have encryption keys.