Digital dilemmas - Communicating with patients by text

MPS advisers answer real dilemmas from the advice line.

We want to start communicating with patients by text, what should we be mindfulof? Dr Richard Stacey, MPS medicolegal adviser, shares his advice

There is no reason why you shouldn’t embrace the benefits of communicating in this way, but you should be mindful of the pitfalls around consent and confidentiality that it presents. For example, patients may change their mobile number, or their friends and/or family could read the message.

You should also bear in mind that text messages do form part of the medical record and any text message exchanges should be recorded therein. They are also not an appropriate way to deal with complex clinical queries.

Here are two scenarios that demonstrate the pitfalls of communicating by text message even when reasonable safeguards have been put in place.

Why are you texting my daughter?

In the middle of a busy Monday morning surgery, Dr J consulted with patient C, a 17-year-old student. C was distraught because several weeks previously she had had unprotected (consensual) intercourse with her 17-year-old boyfriend and her period was now late.

Dr J explained that she would arrange a urine pregnancy test and C agreed to bring in a sample the following morning. C specifically asked Dr J if she would arrange for the practice to send her a text when the result was available as she was currently in the middle of her A-level examinations and as a consequence may not be immediately contactable by telephone. Dr J agreed to this request, took C’s mobile number and documented her consent clearly in the records.

C’s pregnancy test was subsequently returned as being positive and in accordance with her request she was sent a text message which read: “Please contact the surgery”.

Several minutes after sending the text the surgery received a call from C’s father who explained that C was currently sitting an A-level examination, and had left her mobile at home so he had picked up the text.

C’s father was anxious to know why she had been asked to call the practice.

Advice

Although the practice was able to maintain C’s confidentiality while keeping her father on side, the dangers of communicating by text message are evident.

Fortunately, Dr J confirmed and documented C’s consent. The text message C received did not reveal the fact that C had undergone a pregnancy test, nor did it reveal the result.

When communicating with patients by way of text message, you should always be mindful of the fact that persons other than the intended recipient may have access to the message.

The wrong mobile number

Mrs B, a 44-year-old management consultant, attended Dr S’s emergency surgery asking for a sexual health check. She admitted that she had been having an affair with a colleague. The affair was now over and she believed she may be at risk of chlamydia.

She told Dr S that her relationship with her husband was currently very strained. She did not want her husband to know that she had attended the surgery.

Dr S carried out a speculum examination to obtain swabs. Mrs B asked Dr S to text her the results of the tests as she was going to be traveling on business for the next ten days and didn’t want a letter sent or a message left on the house phone. Dr S looked on the screen to check that she had a mobile number for the patient and agreed to her request.

Three days later the result came back that Mrs B was positive for chlamydia. Dr S sent a message to Mrs B which read “Test positive: please contact surgery”. One hour later an irate Mr B was at the desk, stating that he had received the message on his mobile phone.

Dr S apologised that the text was sent in error, but gave no further details. Mr B had had a recent hypertension review with the practice nurse and had asked her to update his mobile number. The nurse was new to the practice and inadvertently accepted the computer’s prompt to update all the household members’ contact details with the new mobile number.

Later that day a distraught Mrs B telephoned Dr S. Her husband had contacted her and she had admitted the affair to him. She subsequently made a written complaint to the practice that her confidentiality had been breached by text.

Advice

Changes to contact details are best undertaken by administrative staff (rather than clinicians in a consultation), in accordance with practice protocols.

Clinicians should double-check contact numbers for patients if they are going to contact them by text for a specific result.

Ensure that default settings on computer systems are for individual telephone numbers and not for all household members.

Useful links

GMC; Confidentiality (2009)

MPS factsheet, Communicating with patients by text message (2014)