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A Primer on Email Etiquette

December 30, 2021
Mikkael Sekeres, MD, MS
Director of the Leukemia Program at the Cleveland Clinic in Cleveland, Ohio
Jennifer Lonzer, MA
Editorial project leader at the Cleveland Clinic in Cleveland, Ohio

Every day, more than 200 billion emails are sent and received, for an average of 122 emails sent and received, per user, in a business setting.1 Having just returned from a week of vacation, we believe that approximately all of those 200 billion emails were waiting for us in our inboxes.

As we spend increasing amounts of our time reading, writing, deleting, avoiding, or embracing these electronic missives, here are our wholly opinionated recommendations for the best way to approach the typed word, with apologies to a previous piece on conference call etiquette.

1. Limit your message to three succinct points – and lead with your best.

We love the rule of threes, which also applies to the number of bullet points that should appear on a PowerPoint slide.

In the 1984 movie "Amadeus," a fictionalized biography of the composer Wolfgang Amadeus Mozart, the curtain has just fallen on the first performance of his opera, "The Abduction From the Seraglio," commissioned for the Holy Roman Emperor Joseph II. When asked what he thought of the piece, the Emperor responds, "There are simply too many notes, that's all. Just cut a few and it will be perfect." The royal ear, and anyone receiving your emails, can only absorb so much information, so keep it brief. When a topic may be confusing or might generate too many questions, pick up a phone and call someone − it's that hidden functionality on your iPhone. We forget that oral human communication is good for the soul, and, if that isn't impetus enough, remember that most smartphone inboxes only display two lines of preview text for each email. If you don't capture the recipient's interest in those two lines, that person may just swipe and delete your unread message.

2. Don't email when angry.

Or drunk. Or emotionally labile, like after viewing the "Downton Abbey" finale. Take a deep breath, and count to 24 hours. The written word can be taken out of context – both in the content of an email you are reading and in the one you are about to send. Studies conducted in the 1960s at the University of California, Los Angeles, found that 55 percent of effective communication derives from body language, 38 percent from tone of voice, and only 7 percent from content – the part that appears in an email.

We have found independently that an email's body language and tone of voice is often hard to interpret, unless using ALL CAPS, WHICH COMES ACROSS AS SHOUTING!!! People can be terse in emails, sometimes because they are annoyed with you, but sometimes because they're multitasking and trying to respond to an email, while simultaneously cooking a meal and mediating conflict between their rambunctious children. (Note: Both authors are guilty of the latter.)

So, rather than assuming the former, reply neutrally and avoid the temptation to over-interpret intent. Similarly, it's a good general rule to never send a deliberately testy or belittling email to anyone else. It's hurtful and it places the receiver in the awkward position of either having to respond or calling you to discuss (which you should have done to start with). Emails are forever, but your job isn't.

3. Review your email before sending it.

Autocorrect is our friend and our foe. It has magically converted the gibberish of our errant typing into cogent sentiments, but has also introduced absurdity into what would ordinarily have been a simple missed keystroke. While these malaprops can be hilarious – unless they are sent to your boss or a prospective client, or in a sensitive email to a patient – make sure you proofread your text before launching it into cyberspace. This is particularly true for the subject line, where that silly typo will remind people of your carelessness, writ large, with every reply or forward.

This goes double for the people to whom you are addressing or copying the email. We have learned through hidden channels that autocorrect and autopopulate belong to the same devious secret society, designed to undermine the confidence of the human race. The authors have both been guilty of sending emails to the wrong person when autopopulate converted, for example, to, derailing our attempt to send the Earl of Grantham electronic fan email.

Worse yet, autopopulate may direct your gushing message to a private email account, when an intended recipient has emailed you in the past from work and home, such as Honest mistake, until that email contains patient identifying information, at which point it becomes a reportable HIPAA violation.

Our advice is to delete these personal/professional email address overlaps from your contact list, or, at the very least, check your intended recipients before hitting Send.

Finally, be judicious with "reply all." We have both been on email chains, addressed to hundreds of recipients, in which a meeting is announced and some feel the need to reply to hundreds of others with "I'll be there" or even "Can't make it, I'll be out on PTO that day." These responses then beget replies, also to hundreds of people, ranging from the tentative "I don't think I should be on this email list" to the dictatorial "EVERYONE STOP REPLYING TO ALL!"

Email is not an opportunity to test-market the new reality show "Real Housewives and Househusbands of Hematology." This may be hard to hear, but a vast audience does not care to know your daily schedule, whether or not you can make a meeting, and the reasons behind your attendance record. Do yourself, and everyone in your organization, a favor and limit your response to the meeting organizer.

On the other hand, we DO want to hear your comments and feedback, so FEEL FREE TO EMAIL US ANYTIME at! (Caps intended.)


  1. The Radicati Group, Inc. "Email Market, 2016-2020," June 2016.

The content of the Editor's Corner is the opinion of the author and does not represent the official position of the American Society of Hematology unless so stated.

Have a comment about this editorial? Let us know what you think; we welcome your feedback. Email the editor at


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