I've had a couple of clinic patients ask for my e-mail address. I gave it to one of them, whose son is a doctor, and who had an e-mail relationship with the previous fellow in the clinic. I didn't give it to the other one, partly because the day after I gave the e-mail address to the first patient, she sent me three long e-mails, and I found myself concerned about setting up a situation where I'm receiving e-mails that I don't have time to read and answer promptly.
I'm not sure what to do about it, as a general rule. There doesn't seem to be a policy, at least not one that I can figure out. The attending I asked said it's up to me. Some fellows do it, some don't. The issue that some doctors in practice have with e-mail is (1) it's not compensated, and (2) liability issues, if you don't reply instantly and something needs to be urgently done about the patient's condition. I think the biggest issue is time. There aren't enough hours in the day to have an e-mail relationship with every patient. And the barriers to someone sending an e-mail feel like they're a lot lower than picking up the phone. There's an expectation that if you call a doctor, they might not get back to you for a few hours, or until the end of the day. That expectation doesn't hold with e-mail, even if a doctor may not actually be checking e-mail for hours in the middle of the day.
On the other hand, who wants to tell patients they can't contact you via e-mail, if e-mail is their preferred method. In other professions, no one would tell a customer they can't send an e-mail if they have a quick question.
It's hard to tell tone over e-mail. It's hard to ask follow-up questions, since you may end up in a days-long back and forth. It's hard to give any advice more specific than, "you should come in just to be sure," which isn't advice that requires an e-mail relationship.
I don't want to e-mail with patients, if there's a choice. There are systems in place to speak to a doctor on call 24 hours a day. There are other ways to ask questions. And yet that feels like a bad attitude, or at least an attitude that doesn't reflect the reality of how people communicate. We can use the Internet without question for so many transactions and relationships-- even many that used to be in person-- grocery shopping, etc. It can't possibly be the case that in the future people won't be e-mailing with doctors. So why does it feel like such an imposition? Why does it feel out of bounds, like a form of communication that is too direct, too easy to abuse, too personal?
We're on the hook for so many hours of the day. To be able to go home and not be on the hook-- yes, there can be phone calls, and messages through the answering service, but it's different, somehow-- doesn't just feel like a relief but like a necessity. People's health issues are important, usually require full attention, and can't be effectively dealt with in the same way you scroll through Facebook posts. You can't half-answer a question and hope it turns out OK. A patient e-mails saying he's feeling x, y, z symptoms and you can't necessarily just flag the message and say you'll deal with it tomorrow. I don't want the responsibility of having to be fully engaged 24/7 with every patient. It sounds bad to say that, but I don't know any other way to express it.