email to communicate with their doctor. These patients were more likely than those unwilling to use email to be younger (mean age 47.1 vs 55.4), have higher incomes ( > $75,000, 32.2% vs 17.0%) and to report better health (self assessed 10pt scale, 7.2 vs 6.5, All p < .01). Patients and physicians reported a number of barriers to use of email: 46.2% of patients who were email users`w ould rather speak to a real person'' and 31.5% thought email``would take too long'' but only 11.1% were worried about privacy at work or home. 47.4% of physicians were afraid they would be overwhelmed with patient emails, 30.2% did not feel they had enough time to check patient emails, and 44.8% felt patient email would add rather than substitute for other tasks. More physicians than patients thought that email could improve the patient-physician relationship (67.0% vs 54.3% of patient email users, p < .05) but physicians were more concerned than patients over security issues (43.2% vs 33.4% of patient email users, p < .05). CONCLUSION: Patients and their physicians are increasingly connected to email but few patients are connecting to their doctors. Our results suggest that patients perceive different barriers to use of email than their physicians. Patients may be more concerned about whether email will substitute for phone calls or visits versus concerns about privacy. Physicians appear to be optimistic about the role of email in improving the patient-physician relationship, but have concerns about privacy and workload. Research is needed to address these concerns about the efficiency, effectiveness and appropriate use of electronic patient-physician communication.