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One of the great disasters of becoming a consultant ophthalmologist is the massive increase in emails that then occurs. Every time I open my inbox in work it seems complete luck whether there are 50 or 90 emails waiting avidly for my attention.

If I am away on holiday for a week or more then the very prospect of opening the inbox at all fills me with such dread that not infrequently I let an extra few days of emails pile up before I summon enough courage to click on the icon and see what’s there. Sometimes many hundreds, or even thousands of new emails await, glistening with their bold font and daring me to click on them and in so doing spill their toxic information all over my brain. Many emails can be instantly dismissed; those about cars with lights left on or new menu choices in the staff canteen to reflect the changing of the seasons.

Most need to be opened first but can then be dismissed; people including huge numbers of CCs in their emails about things only very peripherally concerned with most of those copied in. Some of course are landmines planted among all the others to catch the unwary and ruin your day; a complaint, a complication, a registrar stepped on your patient’s foot and pushed them through a window, there are 71 patients in the clinic next week and you’re the only one in it, you have to be in three meetings simultaneously and all of them are important, your cataract patient was seen in eye casualty (with no details given) or the clinical lead wants a word with you about something (also not stated).

Should email communication be banned? Well, I would love to do so but there are some advantages for very specific things. Very straightforward things. Anything diplomatically complicated or potentially contentious I hope all would agree would be best solved in person or over the phone, with email then being used to confirm the discussion if, for whatever awful reason, that is needed. Not everyone agrees though and sometimes emails expressing concern, anxiety, disapproval or some other negative emotion are sent. But as we live in the ever-polite modern era, this means only the most foolish express their true feelings in a form that can be easily forwarded to others, so a whole form of email regional dialect has grown around conveying negative thoughts in superficially pleasant language. I present a guide here on how to read these emails:


Dear/Hi Gwyn – regular greeting

Gwyn – I am pretty annoyed at you and you will soon see why

As per my previous email – Why have you not done this? Why must I explain myself again to you?

I was surprised to hear that – I am angry and frustrated with you

I was very surprised to hear that – I cursed your name out loud and threw your ‘number 1 ophthalmologist’ mug out of the window

Happy to discuss – I double dare you to call me about this. I know you won’t. Coward

I hope this makes sense – It obviously makes sense. I understand it perfectly. Why don’t you?

Kind regards – Regular farewell

Regards – The ‘I’m peeved with you’ sign off

I wonder why you did x – Are you an idiot?

I wonder why you did x when y was as it was – You ARE an idiot and I am taking the time to point it out to you

I wonder why you did x when y was as it was and z is also about to take place – I loathe you and wish you would resign

I have cc’d in x, y, and z – I am building a George Bush style coalition against you

I read your email with some interest – I just couldn’t believe you would say that to me

Your points are noted – And utterly disregarded for the rubbish that they areI look forward to your response – How are you going to get out of this mess, idiot?

I look forward to your urgent response – Your mess has messed up my own situation now; I hope you’re happy with yourself

I agree with much of what you say – I think you are totally wrong about everything here and also about everything you said in the past about this

I have heard what you’ve said – Now please shut up about it because I disagree with you

One or two comments about – These are 802 reasons why you are wrong yet again

I wasn’t involved in this particular decision – It’s a crazy stupid idea and I am making it plain that I too think it’s nuts

X is not familiar with this particular issue – Not only are they not familiar but their whole contribution is less than worthless

Rather than decide now perhaps we should discuss this issue at the next ophthalmic board meeting? - I am so against this that I will make sure in a meeting of our peers that you are roundly condemned for even contemplating it

Can you please explain to me why – What possible reason could you have for doing this most idiotic of things?

Can you explain to me why – You absolute useless moronic waste of skin I just can’t believe you did this

Please find a document attached containing a previous email thread about this – I just can’t believe you know so little; we discussed this to death already!

I believe you were supposed to be dealing with this – Sort it out! Now!

You might not have understood me – I have no respect for you and can’t believe you won’t just admit you’re wrong so this can end

Let’s discuss this face to face rather than over email – Why the hell are you wasting not only mine but everyone else’s time with this ridiculous issue?

I saw another one of your patients in clinic today – Why are you referring so many? Are you qualified to practice ophthalmology? These are basic things.


In summary, email communication is fraught with danger and the language used is potentially very confusing indeed. Added difficulties arise when increasing numbers of people are copied into a discussion rapidly spiraling downhill and it shows some level of emotional intelligence to know when to switch to a non-email format. Either that, or perhaps we could all agree to be brutally honest in email-speak so that there is less induced anger in reading emails.

But the best solution is severely limiting email communication to bare essentials and being brave enough to confront those people writing an email to 98 people, inside and outside the department, about a sharps not put in a sharps bin, a dictation device not uploading someone’s dictation properly or a clinic that is not yours in some location overrunning, and tell them to take it up only with the relevant people or next time be publicly called out for wasting everyone’s time. Or thrown out of the window alongside the ‘number 1 ophthalmologist’ mug.


The views expressed are those of the author and do not represent those of the editorial team or the publisher.




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Gwyn Samuel Williams

Singleton Hospital, Swansea, UK.

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