How should you respond to patient texts?

Risk Management

Is it Appropriate to Text My Patients?

Question: Since much communication is done by text messaging these days, I wondered: Is it ever appropriate to text a patient or respond to their texts?

Answer: We asked defense attorney Mandi Karvis for her advice on this topic.

Ms. Karvis noted that while the conversation may begin being a simple task (e.g., scheduling), it can easily evolve into something else entirely. A casual “hope you are having a good day” can quickly cross the line into a more personal, and perhaps inappropriate, interaction. Even if the patient is the one to initiate the informal banter, the doctor, as the professional, must be the one to establish the communication boundaries.

Unless there are unusual circumstances, a doctor should not provide treatment recommendations or possible diagnoses to patients via text messaging. Patients should instead be encouraged to make an appointment or to present to the emergency department if it is an urgent situation.

You must also consider how the text messages might be used in the future if the patient experiences a bad outcome and file a board complaint or a lawsuit. In the moment and in context, a text message that might not be interpreted as offensive can be twisted and placed in a different light once the patient is an adversary. For instance, if you are friendly with a patient who experiences what is believed to be an adjustment-related complication and, in the moment, you joke about adjusting them again, it might seem funny. Nevertheless, this comment could later put you in a bad light with a jury.

Text communication with patients can also cause privacy/HIPAA violations, and doctors must follow appropriate security protocols for the storage and transfer of patient information. Nearly everyone has inadvertently sent a text message to an unintended recipient, which can be embarrassing. However, in the context of the provision of healthcare, it can have much more serious consequences. If a doctor unintentionally communicates patient identifying information to someone other than the patient, it could be a privacy violation. Several secure text messaging applications are available for doctors to use for substantive conversations about patient care.

Lastly, Ms. Karvis noted that text message communication with patients can create recordkeeping issues. Patient interactions are supposed to be part of the chart and, in some states, they could be deemed to include text messages. If you are not uniform in which messages you keep and which you delete, it could also give rise to an argument that certain messages were intentionally deleted.

The information in the NCMIC Learning Center is offered solely for general information and educational purposes. It is not offered as, nor does it represent, legal or professional advice. Neither does this information constitute a guideline, practice parameter or standard of care. You should not act or rely upon this information without seeking the advice of an attorney familiar with the specific legal requirements of the state(s) in which you practice. If there is a discrepancy between the site and an insurance policy you have with NCMIC, the policy will prevail.