SEND IT: Study of E-Mail Etiquette and Notions from Doctors in Training Journal Articles uri icon

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  • OBJECTIVES: Worldwide, more than 247 billion e-mails are sent each day. Little empiric evidence is available to guide how e-mail presentation style, tone, and content affect e-mail recipients and whether these factors impact opinions about the sender and the rapidity of response. In a study of physicians in training assessing a series of 100 e-mail examples, we examined the following: (1) formatting characteristics most and least endorsed, (2) impression of the sender based on the e-mail itself, and (3) factors associated with the decision to respond. We reasoned that our study would provide empiric data to support recommendations for e-mail etiquette, focusing specifically on doctors in training. DESIGN: Cross-sectional survey study. SETTING: Division of Orthopaedic Surgery at McMaster University, Hamilton, Ontario, Canada. PARTICIPANTS: After each e-mail, the participating surgical residents completed a series of questions focusing on their impression of the e-mail appearance, their perception of the sender, and their motivation to respond to the e-mail. RESULTS: Thirty-two residents participated in this study. The responses indicate that the key negatively endorsed features of the e-mails included the use of colored backgrounds (84%), difficult-to-read font (83%), lack of a subject header (55%), opening salutations without recipient names (50%), or no salutation at all (42%). The senders of negatively endorsed e-mails were perceived by participants as inefficient (p = 0.03), unprofessional (p < 0.001), and irritating (p = 0.007). E-mails with overall positive endorsements were significantly more likely to have the participants perceive the e-mail senders as professional (p < 0.001), pleasant (p = 0.048), and kind (p = 0.059). The participants were 2.6-fold more likely to respond immediately when they perceived e-mails as favorable compared with disliking them (42% vs 16% of responses, respectively, p < 0.001). CONCLUSION: The e-mails perceived as being disliked overall are likely to result in a negative perception of the sender and delays in response time.


  • Resendes, Sarah
  • Ramanan, Thammi
  • Park, Angela
  • Petrisor, Brad
  • Bhandari, Mohit

publication date

  • May 2012