Ah, the promise of e-mail! The minute I started giving out my address to my patients, I fantasized about how much time I would save on routine phone calls and how clear and unambiguous the communication would be.

Indeed, there was a honeymoon period. Could I change a Monday appointment for Wednesday? Of course. Would I phone in a renewal of Prozac? With pleasure. This was really neat: no more phone tag with patients, just simple requests with simple solutions.

Not for long.

I was beginning to worry about what I had gotten myself into. When patients had only my phone number, I just had to keep track of voice mail; now I had to be on the lookout in my e-mail, too. This was going to make my life easier?

Still, being an impatient person, I love the speed of e-mail. But being a psychiatrist, I am leery about the quality of information it conveys. How can I tell whether my patient is being humorous, sarcastic or ironic? Smiley faces are no substitute for the real thing.