American College of Physicians Ethical Guidance for Electronic Patient-Physician Communication: Aligning Expectations

Philadelphia, PA (June 29, 2020) – Electronic communication (e-communication) is commonplace and can affect the patient-physician relationship. While it has many benefits it must be used thoughtfully and effectively to ensure standards of ethics and professionalism are met and trust in physicians is maintained, according to a new position paper from the American College of Physicians (ACP) published in the Journal of General Internal Medicine.

The position paper, “American College of Physicians Ethical Guidance for Electronic Patient-Physician Communication: Aligning Expectations,” was developed by the ACP Ethics, Professionalism and Human Rights Committee (EPHRC) and offers recommendations for physicians for navigating e-communication, focusing on ethics and professionalism in patient care; privacy and confidentiality; practice considerations in order to try to align patient and physician expectations. It examines e-mail, patient-portals, texting and messaging applications between patient and physician. It does not examine telemedicine, telephone, video or other applications, or communication between clinicians.

The paper notes the ACP Ethics Manual says physicians must act in the patient’s best interests and take care to extend standards for maintaining professional relationships and confidentiality from the clinic to the online setting.

The position paper also notes that communication is critical to strong patient-physician relationships and high-quality health care. Recent advances in health information technology have changed how patients and their doctors interact and e-communications occur through means of e-mail, patient-portals, texting and messaging.

ACP is providing guidance for those e-communications in order to maintain strong and trusted patient-physician relationships and expectations. It’s noted, however, that with changing technologies some recommendations may need to be revisited.

ACP recommendations in the paper include:

  • Electronic communication can supplement in-person interactions between patient and physician but should not take the place of in-person communications. 
  • Electronic communication should only take place after discussion with the patient about expectations and appropriate uses, and with the patient’s consent.
  • Electronic communication with patients should occur through a method that is patient-centered and secure such as patient-portals.
  • All electronic communications should be documented in the medical record. 
  • Electronic communication between patients and their physicians, if done with attention to ethical and other concerns, may help improve patient care, patient satisfaction, and clinical outcomes.
  • Physicians and institutions should use electronic communication to promote health equity and proactively address the socioeconomic and demographic factors that may lead to disparities in uptake and utilization.  
  • Physicians, institutions and patients should recognize and address increased workload associated with management of electronic communication and implications for physician well-being.

“This paper is particularly timely given the COVID-19 pandemic,” said Jacqueline W. Fincher, MD, MACP, president, ACP. “E-communications have become necessary and powerful tools that have the potential to help improve quality, patient satisfaction and access to health information and clinicians but they must be used with care and with clear and mutual understanding of patients and clinicians.”


About the American College of Physicians
The American College of Physicians is the largest medical specialty organization in the United States with members in more than 145 countries worldwide. ACP membership includes 159,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on TwitterFacebook and Instagram.

ACP Media Contact: Andrew Hachadorian, (215) 351-2514​,