April 1999 Bulletin

How to avoid drowning in e-mail Keep messages short, deal with it promptly or put it in 'folders'

By Christopher W. Oliver, MD

Trauma and orthopaedic surgeons have only a limited daily amount of time to use the Internet and e-mail effectively. For beginners using new technologies, the enormous amount of data may be a "turn off" to developing a useful way of using the technology. It is so very easy to become information overloaded.

The reasons for information overload are due to:

• too much information.
• an inability to understand the information, often due to excessive jargon.
• knowing the information exists, but not being able to find it.
• difficulty finding the appropriate information once a useful source is located.
• the coarseness of Internet search engines.
• insecurity of validation and quality of online material.
• When surgeons encounter information overload they will tend to:
• avoid using a particular resource.
• use the resource badly (often due to not reading instructions).
• waste online time.
• slow down development of their own projects.
• increase their own stress levels.

Electronic mailing lists are particularly liable to create information overload. Orthopaedic surgeons who use mailing lists need to learn how to manage their own computer and use the appropriate software and hardware to handle messages effectively. Mailing lists may either:

• take up a lot of surgeons' time.
• cause encounters with irrelevant or "spam" messages.
• create long download times due to large image file attachments.
• be insulting due to "flames."
• contain frivolous chat.
• cause confusion over exact meanings of messages due to lack of face-to-face contact.
• repeat basic questions.

E-mail lists may be improved by the users carefully considering their replies and only sending them after due consideration of their content and readership. Coping with the time it takes to answer e-mail is often learning how to "let go" and is often the most important factor when using mailing lists. E-mail is,

however, particularly useful in that it may be possible to contact people in organizations that you may not have normally had access to. For the person being accessed this may increase their workload. It is often useful to have two e-mail accounts, one for business and one for personal use.

My own policy for dealing with e-mail is to deal with it immediately. I choose to use "folders" in my e-mail to sift my mail automatically into subdivisions from known senders. I can deal with my folders at my leisure. The remaining mail in my inbox will be immediately deleted if they are irrelevant. I do not open messages that are not relevant to me. I immediately reply to messages if my answer is short or put it into a "tasks" folder to act on later. I do not procrastinate; I find it is better to be faster and more efficient to answer immediately and keep my inbox clear. It may be possible to prioritize and delegate especially where the surgeon has a secretary with a reasonable level of computer literacy. Strategies to help time management are:

• a knowledge of personal "time management" is very useful.
• setting goals to decide how much e-mail and Internet time each day should be considered.
• a well-kept electronic address book will help locate e-mail addresses. Storage of the address book on a server will mean it can be accessed from any computer with the appropriate software.
• e-mail distribution lists will save time in sending messages to the same frequently used group.
• careful use of directories to store files and e-mail on the computer or server.
• use of searching and sorting facilities in the e-mail program will help locate lost messages.
• a backup strategy for lost data using a floppy disk, tape drive or re-writeable CD-ROM.
• regular archive of old e-mail messages.
• obsessive use of a virus protection program will help guard against the loss of data.

Good practices when sending e-mail is:

• consider if the message is absolutely necessary.
• use good subject lines.
• keep messages short-no message should be longer than 100 lines otherwise they are unlikely to be read.
• use a four line e-mail auto-signature giving your name, qualifications, institution and contact details.
• distinguish business mail from non-business mail.
• watch where your replies are going, think who really may be reading your message.
• check mailer options; do you really need to send a copy of every message to yourself ?
• delete unnecessary parts of messages when replying.
• check validity of virus warnings; do not circulate hoax messages without checking their validity with a online virus software website.
• don't send attachments to lists, it wastes everybody's time.
• avoid cross posting to lists, it wastes everybody's time.
• when going on holiday suspend mail from lists and do not use a vacation mailer.
• never use obscene language and insults, and shun any racist or sexist remarks. You never know if your mail will be archived permanently by the recipient. Always remember confidentiality at present is not guaranteed with e-mail.

New technologies are allowing seamless integration of e-mail, the Internet and the personal computer which should make information management easier and overload much less of a problem. Remember that with e-mail, organizations can become less hierarchical and the lines of communication open out. Recipients may, however, lack the necessary background information so always be clear and precise to avoid time-wasting misunderstandings.

Christopher W. Oliver, MD, FRCS (Orth) is consultant, trauma and orthopaedic surgeon, Edinburgh orthopaedic trauma unit, Royal Infirmary of Edinburgh, Edinburgh, Scotland.