Background and objective: Although theoretical perspectives on the doctor-patient relationship have characteristically assumed the temporal and physical co-presence of doctor and patient, the advent of email in doctor-patient communication has brought with it a different communicative reality. New technologies come with significant implications as, amongst other things, they impose practices and identities on participants (Malater 2007). The purpose of this integrative literature review is thus to investigate how the advent of email as a medium of communication affects the doctor-patient relationship. Methods: Using the methodology of the integrative literature review (Whittemore and Knafl 2005), 38 articles identified from database searches from 2002-2012 are grouped and evaluated under three headings: the content of email exchanges, patients’ perspectives on email communication and doctors’ perspectives on email communication. Findings: Analysis reveals that greater enthusiasm is generally more evident amongst patients than doctors for email as a medium of communication. Patients identify numerous advantages with email including the possibility of greater empathy due to the informality of the medium, convenience, freedom from the clinical gaze, pseudo-anonymity and greater opportunities for reflection, whilst doctors express concerns about confidentiality, time and the challenge of conveying empathy electronically. Implications: The impact of email on the doctor-patient relationship has hitherto been addressed obliquely, indicating the need for more research in this area. Empirical work could also valuably support the development of theories that would reflect this new communicative reality, replacing outdated ones.
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COMMUNICATION, MEDICINE & ETHICS (COMET), 2013