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Entries in professionalism (2)


Humanizing your emails

Recently a colleague emailed my intern group list-serve without a clear salutation, addressing them as "you." One intern replied to the email, triggering a copy to the whole list-serve, thinking the you was in fact just her, rather than the collective you.

This got me thinking about how often emails mis-fire in this way, and about the root causes.

In today’s world of mobile devices, I have noticed that people sometimes reply to emails without a full appreciation of who was cc’d on the original email, or whether their reply might be going to many people. I think this happens because mobile devices do not display all the meta-data about a message the way we typically see them on larger computer screens.

Sometimes someone who is bcc’d and receives the message on a mobile device, replies to all because their phone does not show cc and bcc lines. Even though this does not reply to all the people who were bcc’d, it DOES reply to all who were cc’d. This can be extremely problematic.

Therefore, for professionalism and safety and quality reasons, I recommend the following practices, which I try to model:

Begin your emails with a salutation that makes it clear who is being addressed, such as “Dear X”. My colleague did not do this, and the use of "you" may have inadvertently misled each recipient.

If you are cc’ing anyone, mention this explicitly after the salutation, such as “Dear X, and cc’ing Y and Z”

Never bcc anyone. If you want them to see the message, forward it to them after sending.

Be aware when replying to a message that if the message originated as part of a distribution list (list-serve), your reply may go back to the whole list-serve by default, even if it looks like you are only responding to a named sender.

Generally be aware that people may be reading your email on a mobile device with a small screen and more limited formatting options, and in different time zones on devices that may or may not adjust for time zone differences.

If you can, avoid attachments. Paste useful content into the body of the message – with minimalist formatting. People often don’t see that attachments are included, especially if they are checking email on phones. Recently I was in a meeting where someone had received a bunch of attachments but denied getting attachment #7. Their email program (Outlook) displayed two lines of attachments and then you have to scroll to see more attachments. Which this person did not know to do. Therefore they kept denying that they had received attachment 7, even as the sender insisted it was attached. Attachment 7 was a critical part of a proposal that ideally would have been reviewed before the meeting. So if you do include attachments, list them in the body of the email in a numbered list.

Take the time to compose emails that short-circuit several cycles of communication. For example, when trying to arrange a meeting with someone, propose 1 definite time and offer 3 available backup times. Specify time zone. Always include an absolute date (never “tomorrow” or “Friday”). See my blog article on fully specified requests at When a meeting is confirmed, I will typically send an email with all the pertinent details (date, time, call-in information etc) and send a calendar invite with that information in both the "location" and note fields. The huge advantage of calendar invites is that they generally appear grayed out on people's calendars until they are accepted. Even if recipients overlook the email, they will usually notice something appearing on their calendar. However, email systems are not fully interoperable, so calendar invites may not function for others the way they do for you. That's why I do send a duplicate email summarizing the calendar item for people who are outside of my organization.

Generally in all communications, do some perspective switching and anticipate how the message is going to be received, accessed, interpreted, stored, and shared. The best book I have ever read on strategic communication, in which you anticipate the first, second, and third-order effects of your messages, is the book “When talking makes things worse”. Out of print, available at your library. Along these lines, use the subject line to summarize any request and deadline, as recipients do review subject lines while screening emails. Make judicious use of any ways to flag emails. My email system allows me to add an urgent mark (!), plus request a delivery receipt and read receipt, and schedule a reminder to emails. These layers communicate to recipients that I really, really want to make sure the email does not slip through the cracks. Overusing such flags will backfire, but generally I have good results with them. However, as with other issues, you cannot assume they will work similarly on all email systems.

As for the actual contents of the email, I try to limit each email to a single topic that matches the subject line, and structure the email so that a recipient can respond with a yes or no or very simple and short response, and move our collaboration forward. Finally, as with all communication, proceed with curiosity, fallibility, and perspective-taking. The primary implication of these is that I am always testing my assumptions with my respondents ("Did I understand correctly that you are requesting X, or am I missing something?"). Look over an email and count the question marks before you send it. Typically people make 10 or more statements for every question. When I review transcripts of really productive conversations, I find ratios more in line with 3 or 4 statements for every question. How do you feel when people communicating with you include questions to test their assumptions or solicit your views? My guess is you feel included and collaborative. The philosopher Immanuel Kant pointed out that a key ingredient of humanism was treating people as ends in themselves, not as means to an end. My experience is that asking questions is inherently humanizing.

When I look over these strategies for composing professional emails, they boil down to reconstructing the context for face to face, heart to heart communication that is otherwise likely to go missing from the electronic medium. Context such as the who, what, when, where, and why surrounding the communication. Context is humanizing. What a strange word, humanizing. Why would we need to humanize anything that we are involved with? Isn't our mere presence in an activity inherently humanizing? Well, no, not in the sense of being humane to each other. Something we need to keep in mind when communicating through machines.

As I write this, I've begun to hum one of my favorite songs, Rehumanize Yourself, by The Police, on the great album, Ghost in the Machine. "I work all day in a factory/I'm building a machine that's not for me/There must be a reason that I can't see/You've got to humanize yourself." If we are to build machines through our emails, let's build them for and with each other.


Tips for premeds on shadowing doctors


One of my interns asked me about shadowing doctors. Shadowing any professional is a great way to learn more about a field. In their new book, Decisive, Chip and Dan Heath point out how we often make career choices with very little knowledge of the professional reality in that field.

For assistance on this question, I emailed our network of 60+ intern alumni, who are mostly in or just emerging from medical school, and asked for their advice.

Here's what they said would be considerations in shadowing doctors...


  • Emergency departments
  • Specialty clinics
  • Community health centers
  • Private practices

The type of work that you want to see

  • Interventional
  • Surgical
  • People/talking
  • Family-heavy
  • Research
  • Administration

What do you want to learn/establish from the experience?

  • Get the gist of what a clinic feels like
  • Mentorship relationship with one of the doctors
    • If they are an alumnus of a certain school that you are applying for, this could be very helpful in the application process
  • Research positions
  • Guidance on the application process  
    • The practice of medicine is so varied and individual, so you should take this time to explore in a broad and open way
  • You do not need to choose a specialty at this point in time; it is more important to determine what type of activity drives you
    • Eventually, you will find “your people” with whom you’ll enjoy spending 80 hours a week during residency and for the rest of your career
  • Because medicine is such a long road, you should love it to get through it
    • The only way you can know is if you experience a doctor’s life
    • After the experience, do a self-reflection and be honest with yourself about whether medicine is the right thing for you

How to contact doctors 

  • Email request or in-person
  • 1 paragraph statement of interest/your background
  • Mention if you have already worked with patients