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The issue of trust has increasingly attracted attention in the business ethics literature. Our aim is to contribute further to this literature by examining how the use of the carbon copy (cc) function in email communication influences felt trust. We develop the argument that the use of cc enhances transparency—representing an important characteristic of workplace ethics—and hence promotes trust. We further argue that a downside of the cc option may be that it can also be experienced as a control mechanism, which may therefore negatively affect trust. The results of our first study showed that the use of cc indeed enhances perceived transparency, but at the same time also leads to the experience of increased control. Building upon this insight, the findings of five subsequent studies consistently revealed that the use of cc negatively influences felt trust. More precisely, employees felt trusted the least when the supervisor was always included in cc (Studies 2 and 3). This effect on felt trust also negatively influenced how trustworthy the organizational climate was perceived (Study 4). We further replicated these results in two field surveys, which showed that the negative effect of cc on felt trust lowered perceptions of psychological safety (Study 5) and contributed to a culture of fear (Study 6). Taken together, our findings suggest that when transparency in email communications is experienced as a control mechanism, its use is perceived as unethical, rather than as ethical. Implications and recommendations for future business ethics research are discussed.

Clinical communication is central to the delivery of effective, timely, and safe patient care. The use of text-based tools for clinician-to-clinician communication-commonly referred to as secure messaging-has increased exponentially over the past decade. The use of secure messaging has a potential impact on clinician work behaviors, workload, and cognitive burden. The objective of this study is to investigate the relationship between conversational multitasking-engaging in multiple concurrent, text-based secure messaging conversations-and clinician workload and cognitive burden for inpatient care. This observational cohort study included attending physicians, trainee physicians, and advanced practice providers who worked in an inpatient setting at 14 academic and community hospitals affiliated with a large academic medical center in the United States between February and April 2023. The primary exposure was the maximum number of concurrent secure messaging conversations a clinician engaged in during a workday. The co-primary outcomes were total time spent on the electronic health record (EHR; EHR time) and number of switches between patient charts (patient switching) on that workday. Linear mixed-effect models were used to measure the association between the maximum number of concurrent secure messaging conversations, EHR time, and patient switching on the clinician-day level, after adjusting for covariates (age, gender, total secure messaging volume, patient load, and clinical service assignments). In total, 50,027 clinician-days involving 3232 clinicians (1798 females, 56%; median age 37, IQR 32-46 y) and 3,556,562 secure messages were included. Median EHR time per day was 307 (IQR 204-413) minutes, and the median number of patient switches per day was 107 (IQR 60-176). Compared to clinician-days with no concurrent secure messaging conversations, engaging in a maximum of 2, 3, and 4 or more concurrent secure messaging conversations was associated with an increase in EHR time of 20.3 (95% CI 18.2-22.4), 38.0 (95% CI 34.9-41.1), and 54.8 (95% CI 50.6-58.9) minutes, respectively. Similarly, compared to clinician-days with no concurrent secure messaging conversations, engaging in a maximum of 2, 3, and 4 or more concurrent secure messaging conversations was associated with 14.5 (95% CI 11.3-17.7), 26.7 (95% CI 21.9-31.5), and 41.6 (95% CI 35.2-48.1) additional patient switches, respectively. Stratified analyses showed that trainees experienced the largest increases in EHR time (up to 82.3 min, 95% CI 73.2-91.4) and patient switches (up to 61.8, 95% CI 54.3-69.3). Higher levels of conversational multitasking were associated with increased EHR time and more patient switches in a dose-dependent manner. These results suggest that conversational multitasking may be linked with increased clinician workload and cognitive burden, emphasizing the need for guidelines and interventions to streamline secure messaging use in clinical practice.

his study investigates email pragmatic instruction in four sets of international English textbooks. The prevalence of email communication in today’s technology-mediated world necessitates its inclusion in second language classroom instruction. However, our analysis of the books reveals inadequate attention to the sociocultural aspects of email writing. The analysis also indicates limited opportunities for learners to notice form-function-context connections, engage in output practice, and reflect on their pragmatic performance. These findings underscore the gap between research recommendations and current teaching practices, highlighting the urgent need for textbook writers to integrate research findings for enhanced pragmatic instruction. The findings also provide recommendations for teaching email communication in the second language classroom.

Online surveys have become a key tool of modern health research, offering a fast, cost-effective, and convenient means of data collection. It enables researchers to access diverse populations, such as those underrepresented in traditional studies, and facilitates the collection of stigmatized or sensitive behaviors through greater anonymity. However, the ease of participation also introduces significant challenges, particularly around data integrity and rigor. As fraudulent responses—whether from bots, repeat responders, or individuals misrepresenting themselves—become more sophisticated and pervasive, ensuring the rigor of online surveys has never been more crucial. This article provides a comprehensive synthesis of practical strategies that help to increase the rigor of online surveys through the detection and removal of fraudulent data. Drawing on recent literature and case studies, we outline several options that address the full research cycle from predata collection strategies to validation post data collection. We emphasize the integration of automated screening techniques (eg, CAPTCHAs and honeypot questions) and attention checks (eg, trap questions) for purposeful survey design. Robust recruitment procedures (eg, concealed eligibility criteria and 2-stage screening) and a proper incentive or compensation structure can also help to deter fraudulent participation. We examine the merits and limitations of different sampling methodologies, including river sampling, online panels, and crowdsourcing platforms, offering guidance on how to select samples based on specific research objectives. Post data collection, we discuss metadata-based techniques to detect fraudulent data (eg, duplicate email or IP addresses, response time analysis), alongside methods to better screen for low-quality responses (eg, inconsistent response patterns and improbable qualitative responses). The escalating sophistication of fraud tactics, particularly with the growth of artificial intelligence (AI), demands that researchers continuously adapt and stay vigilant. We propose the use of dynamic protocols, combining multiple strategies into a multipronged approach that can better filter for fraudulent data and evolve depending on the type of responses received across the data collection process. However, there is still significant room for strategies to develop, and it should be a key focus for upcoming research. As online surveys become increasingly integral to health research, investing in robust strategies to screen for fraudulent data and increasing the rigor of studies is key to upholding scientific integrity.

In 1999, the inaugural editorial of the Journal of Medical Internet Research underscored the imperative to evaluate the patient-physician relationship amid the advent of internet-driven medical practices. Even at that nascent stage, views diverged sharply. Some anticipated that novel communication technologies would enhance closeness between physicians and patients. Others feared these technologies signaled a degradation of interpersonal connections and a dehumanization of health care experiences. Reflecting on years of developments, we consider this an opportune moment to reassess transformations in patient-physician interactions, in which notions of distance and proximity are redefined in some unexpected ways. In this paper, we intend to focus on teleconsultation and tele-expertise, the two most commonly used services in our field, dermatology. To navigate these changes, a sociological perspective inspired by Isaac Joseph's theoretical framework has been adopted. Joseph posits that service-oriented relationships depend on 3 core skill sets among participants: technical, civic, and contract management. In medicine, these translate to the clinical, social, and contractual aspects of care. Telemedicine programs introduce significant shifts and adaptations across these dimensions. A primary challenge in telemedicine is the absence of comprehensive sensory information, a crucial component of traditional medical assessments. This article discusses how such technical alterations impact medical practice and necessitate a redistribution of roles. Telemedicine is not merely about adapting existing technical skills; it also demands new competencies, often referred to as \"invisible work,\" to make telemedicine work. Beyond its clinical dimensions, the therapeutic relationship is inherently social. It involves sending signals that confer respect and recognition of the other as a person. A common concern is that telemedicine might lead to reification, that is, turning human patients into objects to serve researchers and physicians, and although extensive literature suggests that physicians develop various strategies to mitigate this, other studies indicate an increased risk of reification in constrained contexts. Contract management skills consist of the parties involved reaching an agreement on the purpose of the service-related relationship and its practical applications. In telemedicine, this may involve reminding the patient that not everything can be done remotely. Through this analysis of the three components of the service relationship as defined by Joseph, we have highlighted the profound changes affecting the physician-patient relationship in the context of telemedicine. Dehumanization is an inherent risk in any medical health care partnership, regardless of whether patient care is delivered face-to-face or at a distance. While some studies have clearly documented the dehumanizing tendency of some telemedicine practices, telemedicine itself is neither reifying nor dehumanizing. The organizational arrangements, the context of work activities, the modalities of use in situ and the types of technological devices used are all contributing factors in defining the level of humanization in remote health care interactions.

We used a mixed-methods approach to characterize and understand the content of secure messages exchanges between patients with type 2 diabetes and their healthcare teams.UnlabelledWe used a mixed-methods approach to characterize and understand the content of secure messages exchanges between patients with type 2 diabetes and their healthcare teams.

Nowadays, email communication is considered the most common and widespread computer-based tool that students use to communicate with their professors. This paper provides a framework for evaluating email communication between students and professors and examines the factors that may influence students’ email style and professionalism. The research was conducted among Serbian and Slovenian students who contacted their professors by email. In order to evaluate the style of student email communication, the degree of formality, and the layout, we developed an evaluation form. Students were asked to complete an online questionnaire that assessed their attitudes toward culture, attitudes toward their professor and studies, digital literacy, use of social media, and self-perceptions of their communication skills. Responses were analysed and structural equation modeling was used to test seven hypotheses predicting the effects of factors that influence writing style in emails. As expected, the results show several differences in these factors in the two countries. First, in both countries, students’ perceptions of their own communication skills influence their email communication style. Second, grade point average has a significant effect on email communication in Serbia but not in Slovenia, while attitude toward the professor is a significant predictor of email communication in Slovenia but not in Serbia. Moreover, in both countries, attitude toward professor is influenced by attitude toward study. Third, digital literacy has a significant effect on students’ perceived communication skills in both countries, while culture affects communication skills only in Slovenia and social media use only in Serbia.

Communication among health care professionals is essential for effective clinical care. Asynchronous text-based clinician communication-secure messaging-is rapidly becoming the preferred mode of communication. The use of secure messaging platforms across health care institutions creates large-scale communication networks that can be used to characterize how interaction structures affect the behaviors and outcomes of network members. However, the understanding of the structure and interactions within these networks is relatively limited. This study investigates the characteristics of a large-scale secure messaging network and its association with health care professional messaging behaviors. Data on electronic health record-integrated secure messaging use from 14 inpatient and 282 outpatient practice locations within a large Midwestern health system over a 6-month period (June 1, 2023, through November 30, 2023) were collected. Social network analysis techniques were used to quantify the global (network)- and node (health care professional)-level properties of the network. Hierarchical clustering techniques were used to identify clusters of health care professionals based on network characteristics; associations between the clusters and the following messaging behaviors were assessed: message read time, message response time, total volume of messages, character length of messages sent, and character length of messages received. The dataset included 31,800 health care professionals and 7,672,832 messages; the resultant messaging network consisted of 31,800 nodes and 1,228,041 edges. Network characteristics differed based on practice location and professional roles (P<.001). Specifically, pharmacists and advanced practice providers, as well as those working in inpatient settings, had the highest values for all network metrics considered. Four clusters were identified, representing differences in connectivity within the network. Statistically significant differences across clusters were identified between all considered secure messaging behaviors (P<.001). One of the clusters with 1109 nodes, consisting mostly of physicians and other inpatient health care professionals, had the highest values for all node-level metrics compared to the other clusters found. This cluster also had the quickest message read and response times and handled the largest volume of messages per day. Secure messaging use within a large health care system manifested as an expansive communication network where connectivity varied based on a health care professional's role and their practice setting. Furthermore, our findings highlighted a relationship between health care professionals' connectivity in the network and their daily secure messaging behaviors. These findings provide insights into the complexities of communication and coordination structures among health care providers and downstream secure messaging use. Understanding how secure messaging is used among health care professionals can offer insights into interventions aimed at streamlining communication, which may, in turn, potentially enhance clinician work behaviors and patient outcomes.

This qualitative study investigates how Greek university students navigate the complex dynamics of their hierarchical student–faculty L2 email interactions. In doing so, it examines students’ perceptions and metapragmatic judgments of politeness and appropriateness byanalysing authentic emails exchanged in academic contexts. It uses interviews with Greek undergraduate students (advanced learners of English), and, through thematic analysis, it explores the extent and the way in which cultural values and sociopragmatic norms might impact the learners’ metapragmatic judgments regarding email writing. Thematic analysis revealed that the students draw on their own culturally embedded frameworks, shaped by Greek norms of politeness, respect and deference, to guide their email evaluations. They prioritise formality as an essential component of email politeness, linking it to professionalism, clarity and respect. Politeness and respect emerged as intertwined concepts, with students emphasising the importance of acknowledging power dynamics and expressing deference to authority figures through formal framing moves, email mechanics and email structure. Cultural values, particularly the Greek norm of heightened respect for authority and older individuals, deeply influenced learners’ perceptions regarding formal greetings, email mechanics and careful phrasing. Additionally, learners demonstrated a desire to tailor their communication style based on the recipient’s status, age and familiarity, attesting to their sociopragmatic awareness. The findings overall underscored the interplay between cultural values and learners’ pragmatic awareness, offering valuable implications for the teaching of email pragmatics and intercultural communication in academic contexts.

This paper examines how commoditization as perceived by online subscribers affects the relationship between email communication exposure and trust. The study conducted a survey among customers of services in three different markets, each characterized by varying levels of service commoditization. To assess perceptions of commoditization (a second-order formative construct), the research utilized first-order constructs, including service/industry homogeneity, customer price sensitivity, and the costs associated with switching providers. This operationalisation was used to gauge the service commoditization in each market, aligning with the positions reported by the service providers. The results revealed that commoditization only weakly moderates the relationship between email communication and trust in two of the samples. By highlighting the moderation effect of commoditization perception, this research contributes to our understanding of how market conditions can influence the relationship between communication strategies, such as email communication, and the development of trust in online subscription services. These findings have important implications for service companies operating in increasingly commoditized markets.