Ask a business executive what they think about corporate e-mail, they'll tell you: "I love it! It's so efficient!"
As any nurse practitioner what they think about secure patient e-mail, they'll tell you: "I hate it. It's so inefficient."
So why the difference?
Perhaps because corporate e-mail is often one-way transmissions of information (broadcasting) so the information can often be ignored. We do not have the luxury of ignoring e-mails in medicine. These e-mails are always two-way, very personal communications, often about significant patient concerns. For nurses and doctors, there is a remarkable efficency in punching 10 munbers on a phone and speaking with the patient directly, or if they're not there, leaving a message acknowledging that you tried to connect. With e-mail, typing much more to compose an e-mail is just not as efficient as the spoken word and invariably takes much longer to craft a response that is accurate and grammatically correct.
Further, e-mail lacks the subtlties of the emotion conveyed with the spoken word. You can't hear the tremulous nature of the patient's voice or the patient's rapid breathing in the background. Worse, responses in e-mails might be misconstrued by the patient. Defusing such concerns quickly is impossible by back-and-forth e-mail communication. Finally, if the doctor or nurse has the caps-lock key depressed, IT MIGHT BE PERCEIVED THAT YOU ARE SHOUTING AT THEM!
Certainly, electronic communication has its advantages at times. Simple, quick questions that are reaffirmation of appointment times, clarifications, or reminders can be efficiently managed to everyone's satisfaction in medicine, but to look to e-mail as the way to cut office clerical staff as a means of cost-cutting, is missing the forest for the trees.