Email and text are for rescheduling and clerical fixes, not clinical care, and you should say so early. Nobody recovers by email; anything of substance, urgent-seeming fires and intrusive messages all belong in the appointment.
Set the expectation early
Set expectations very early that text and email are not for clinical purposes; they are for rescheduling. Make it clear early on that you are not a friendly emailer.
“I set expectations very early that the use of text and email is not for clinical purposes. It's for rescheduling. I also established super early on that I am not a friendly emailer”
18:28Tips to Avoid Burnout in Psychiatry (Outpatient, mostly)Mar 2026 The expectations you send change how the patient responds to the content of an email. Establish early that messaging is not how you work together.
“The expectations you send will change how the patient responds to the content of the email. I established very early that email and messaging is not how we work together”
19:14Tips to Avoid Burnout in Psychiatry (Outpatient, mostly)Mar 2026
How we handle messages
Anything of substance that is not a clerical or EMR error has to be handled in the appointment.
“But for anything of substance that isn't related to some kind of a clerical or EMR error, you've got to do that in that appointment”
20:54Tips to Avoid Burnout in Psychiatry (Outpatient, mostly)Mar 2026 Even if something seems urgent, do not try to put out the fire unless it is a true emergency. Offer to get the patient into the schedule as soon as you can, if that is appropriate.
“Even if there is something urgent, don't try to set out, put out that fire unless it's a true emergency. Say, let's get you into the schedule as soon as we can, if that's appropriate”
15:01Tips to Avoid Burnout in Psychiatry (Outpatient, mostly)Mar 2026 Ideally, frontline staff such as a clerk, receptionist, nurse or social worker manage the messages.
“in the ideal world, in my opinion, the best setup is that you do have some kind of a first frontline staff, whether it's a clerk, receptionist, nurse, social worker, somebody should be frontline in order to manage messages”
17:14Tips to Avoid Burnout in Psychiatry (Outpatient, mostly)Mar 2026
Pitfalls
No one meaningfully recovers through email and texting; it is not an acceptable treatment modality. Being overly interesting or validating in your emails implicitly encourages that mode of communication.
“no one is going to meaningfully recover or get better from email and texting i'm sorry that is not a standard or acceptable treatment modality and the more we sort of lean into encouraging even implicitly by being overly interesting or validating on our emails that mode of communication”
20:06Tips to Avoid Burnout in Psychiatry (Outpatient, mostly)Mar 2026 More contact is not necessarily better treatment. Like having an MRI available any time, it leads to panic and anxiety and keeps the patient from sticking with one set of findings.
“If you could have access to an MRI anytime, That would mean unnecessary imaging that would cause panic and anxiety and keep you from sticking with one set of findings. Right. Getting more information or contact with the doctor is not necessarily a good thing for treatment”
16:50Tips to Avoid Burnout in Psychiatry (Outpatient, mostly)Mar 2026 Clinicians who say they are working until 8 p.m. are usually writing emails that are way too long and way too friendly.
“every person I've supervised, when they say they're working until 8 p.m. or whatever, I go through their emails and I'm like, this is way too much. This is way too much. This is way too friendly”
21:07Tips to Avoid Burnout in Psychiatry (Outpatient, mostly)Mar 2026
Talking to patients
If a patient sends intrusive emails, talk about it in the session: say this is not how you work, ask why it is happening, and discuss what the emails say.
“And if the patient's sending intrusive emails, I've gotten more and more comfortable with saying like, you know, talking about it. This is not how I really work. Why do we think we're having this? Talk about patients who are sending me emails. Talk about the content of the emails”
23:01Tips to Avoid Burnout in Psychiatry (Outpatient, mostly)Mar 2026
From these episodes
- Tips to Avoid Burnout in Psychiatry (Outpatient, mostly)Mar 2026 · 9 points
Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.