Handout: Beginning E-Mail and Discussion Lists

FPEN Internet Training
http://fpen.org/train

Handout: Beginning E-Mail and Discussion Lists
Revised: September 13^th, 1999

I. Objectives

Demonstrate the ways in which e-mail can benefit you in your practice and professional life
Demonstrate and become familiar with basic e-mail techniques.
Introduce the concepts of discussion groups
Become familiar with e-mail etiquette
Understand the promise and pitfall of using e-mail for physician - patient interaction.

II. Benefits of e-mail

Nearly instantaneous connections between people throughout the world.
Messages can be made secure where the identity of the sender can be assured and only the recipient will be able to read the message
Messages can be accessed and handled at your convenience, 7 days a week, 24 hours a day.
Provides a written, editable record of professional exchange. 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 distant areas.
Asynchronous communication
E-mail messages are easy to transport, to reply to, to search, and to send to multiple recipients.
Some people feel less inhibited in sharing their thoughts in an e-mail message

III. Creating an E-mail message: Basic Rules

All e-mail messages need the following two components: an address to which the message is to be sent 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.

Signature: This is a customizable block of copy that is automatically attached to outgoing e-mail. It identifies the e-mail sender, his/her affiliation, city, state or country, and ways to reach him/her via telephone, fax, or e-mail.

On occasion you cannot reply to the sender of an e-mail message. It may be necessary to use the address in the signature block to create a new e-mail message, instead of replying automatically to the sender of the message.
E-mail addresses have a specific anatomy. Typically it takes the form UserID@machine.subnet.company.domain or it may simply be UserID@company.domain. It can be helpful to think of the address as: Name@StreetAddress.City.State.Country. A few examples of e-mail addresses are:

paul@allina.com
paul@fpen.org
kleeberg@medformation.com
Geek_MD@hotmail.com
GradStudent@gold.tc.umn.edu

When typing an e-mail address, 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, or to merely "reply" and not to retype them, if at all possible.
A descriptive subject line is important. This will allow for easier searching through a large number of messages. It lets your recipient scan incoming messages for ones of interest and allows you to browse archives or folders of old messages to find the one you need.
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 to remind your reader of context.
It is often wise to 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. For example:

Paul Kleeberg, M.D.          O   o           paul@fpen.org
Allina Health System        -+---+-    Voice: 612-775-1338
1375 Willow Street           |_o_|       Family Practice &
Minneapolis, MN 55403 USA   / \|/ \   Information Services

Reread the message text and double-check the recipient(s) addresses in both the To: and cc: fields.

IV. Address books

Address books can be set up to save e-mail addresses for individuals.
Groups, representing collections of addresses, can be set up to make it easy to send e-mail messages to more than one person such as members of a committee.
Address books make it very easy to address messages because you can use your friend's nickname to have the machine complete the remainder of the address.

V. Discussion groups

Discussion groups or listserv lists can be thought of as e-mail distribution lists. One must subscribe to a list and then messages sent to the list by others will begin to arrive in your e-mail box.
They consist of "threads" or postings discussing particular topics, but they usually arrive moments after their author sends them. Because individuals usually have to subscribe in order to be able to post a message, 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 screened. Subscribing to moderated lists can greatly enhance the relevance of the list and cut down on e-mail "noise".
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.
Messages from lists can be delivered one at a time to your mailbox, or most lists will allow you to request that they be delivered in digest format (collected in one large message) once a day.
Like the use of the Internet, the use of discussion groups has grown rapidly over time. As of 9/93 there were over 2,300 lists; 12,850 by 11/95; and over 90,000 as of 8/98.
There are several web sites that can help you find a discussion group that may interest you:

http://www.liszt.com
http://www.lsoft.com/lists/listref.html
http://www.tile.net/listserv
http://www.neosoft.com/cgi-bin/paml_search/

The Medical Matrix meta-site (http://www.medmatrix.org) also provides links to forums on nearly every medical specialty.
One typically subscribes to a discussion list by sending an e-mail with the following content: "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):

listproc@fpen.org
(name of list software) @ (machine.domain)

Discussion group address (used for posting messages to all members):

Fam-Med@fpen.org
(name of list) @ (machine.domain)

DO NOT send requests to sign off from a list to the discussion group address. Doing so is like having your request to stop receiving the New York Times appear on their editorial page - many will read it but not the person who can change your subscription.
DO NOT complain about getting an excessive number of messages in your mailbox to the list. To do so only perpetuates the problem. It may seem obvious but it is surprising how many list members do this.
Some discussion groups are VERY active and you can receive a high volume of messages each day, so be prudent when subscribing to them.

VI. Discussion list etiquette

Beware of strong emotions.
Always include a signature so that people can contact you.
Copy the essence of a message when replying, not 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 or overlooked in a busy person's crowded mailbox.
Keep your posting to a discussion group relevant to the topic of the list.
Be careful when using all caps in a message; it is considered to be the equivalent of shouting.
If you are asked to talk about a commercial interest of yours, be sure to remove all advertising hype and testimonials, and be concise. Clearly state in your message that you have a financial interest in the product.
And most important of all, check to whom you have addressed your e-mail message before sending it. We’ve all been embarrassed by sending a message to someone we didn’t mean to include.
For a more complete copy of discussion list etiquette, please see http://fpen.org/lists/etiquette.html

VII. Security issues

Always back-up important files on your computer. Crashes occur and are unpredictable. Would you drive an uninsured automobile?
Caution should be used when opening files from someone else. Any file from another computer no matter how trusted, may contain a virus. This can also be true with attachments to e-mail. The best practice is to only use files when you know the source and be sure your system is backed up.
The decentralized nature of the Internet itself, and the circuitous route that a typical e-mail message will follow, means that most e-mail should be considered public communication. System administrators have access to incoming and outgoing messages. You should also be aware that recipients can easily forward e-mail. For this reason, communicating with patients about their health problems is a risky business.
Secure e-mail is possible using encryption technology where the sender and the receiver have encryption keys. This will also allow you to verify that the sender is who he says he is and that only the intended recipient will be able to read the message.
For a more thorough discussion of the clinical use of electronic mail with patients, see "Guidelines for the Clinical Use of Electronic Mail with Patients", Journal of the American Medical Informatics Association http://www.amia.org/pubs/pospaper/positio2.htm.

Paul Kleeberg, M.D.         O   o          paul@fpen.org
Allina Health System       -+---+-    Voice 612-775-1338
1375 Willow Street          |_o_|      Family Practice &
Minneapolis, MN 55403 USA  / \|/ \  Information Services