Email consultations may help determine whether referral is necessary and facilitate timely specialty advice.^1,2 Some specialties are better suited to email consultations from general practitioners than others, particularly when images are necessary (eg, dermatology vs surgery). There are exceptions, of course, particularly when the question involves a simple procedure (eg, ideal suture choice for a specific clinical situation); however, in complex or sensitive cases, a telephone consultation or other form of communication is likely to be more efficient and effective.

There are some risks when using email for medical consultations.³ The primary care veterinarian and the specialist both have professional, legal, and ethical responsibilities in accordance with professional standards and government regulations. The specialist may not have a veterinarian-client-patient relationship with the client, so any recommendation may be biased by incomplete information provided by the requestor. Confidentiality is paramount, so it is appropriate to maximize the security of the clinic’s server, and other forms of security should be considered to ensure confidentiality, authenticity, and integrity of email information.^3,4 

When approaching an email consultation request with a specialist, consider the following guidelines:

Provide the signalment and moderately detailed history of the course of the disease. The duration of time in which the condition has developed and progressed over time can be helpful to the specialist. 

Consider attaching relevant diagnostic test information when results are complex or difficult to convey concisely. Information may include CBC, serum chemistry profile, urinalysis, endocrine function tests, culture and susceptibility panels, cytology and histopathology reports, and radiographs.

Prescribing information, such as drugs, dosages, and durations of specific treatments, should be outlined. Do not assume that a “course” of any treatment will be universally understood; a “course of antibiotics” could mean 7 days, 10 days, 3 weeks, or longer. Details help ensure clarity.

Images should be shared, when appropriate, as they can be immensely helpful in some referral cases (eg, dermatology, ophthalmology). Images should characterize changes or lesions representative of the disease, and 2 to 3 images are typically adequate. The images should be of good quality, in focus, and accessibly sized. Images should be referenced in the body of the email to provide context for the consultant. 

Provide the specialist with a clear question or questions to be answered. Generalizations or vague questions about case management can slow the process. 

Provide clear contact information for alternative ways for the specialist to communicate with the primary care practitioner. A single email message is sometimes insufficient, and a call from the specialist may facilitate better discussion on a case. 

Your location and clinic should be included. Your full name, clinic name, and location should all be found in the signature line of your email. The clinical considerations and response type to a consultation request may differ depending on the geographical location of the clinic.

Abbreviations, acronyms, or colloquial terminology must be avoided. Communication should not allow for any error because of the use of confusing or mixed abbreviations.⁵ For example, “ADR” could mean “ain’t doing right,” but it could also mean “adverse drug reaction.” If abbreviations are used, define them when first used in the email.

As Albert Einstein said, “Everything should be made as simple as possible, but no simpler.” The specialist should receive all the data that may result in educated input into the case, but try to keep it within 2 to 3 paragraphs. 

Remember, this communication becomes a part of the medical record and should be regarded as a legal document.⁶ Confidentiality is paramount, and responses should not be shared with anyone without specific permission. 

Remember to maintain professionalism and consideration. In addition, this communication becomes a part of the medical record and should be regarded as a legal document.⁶ Confidentiality should be paramount, and responses should not be shared with anyone without specific permission. Liability may vary with the specialty, type of consultation requested, and whether there is payment for the services.⁶