Patient texting – let’s be careful out there
Texting is an important means of communicating with patients, but GPs should be mindful of the potential for breaches of confidentiality
Dr Diarmuid Quinlan, General Practitioner, Woodview Family Doctors, Cork City
December 8, 2017
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The number of text messages sent to patients by Irish GPs is substantial, and growing rapidly. Recently published research demonstrates that a majority of Irish GPs currently text patients, with others on the cusp of initiating text messaging with their patients.1 The GPs identify time management and improved patient communication, especially for the hearing impaired, as being among the key benefits of texting patients.
The UK General Medical Council (GMC) acknowledges that text messaging “can be convenient and support effective communication between doctors and patients”.2 The Irish Medical Council (IMC) is silent on the specific topic of text messaging, although it does have rules concerning information provided to patients and use of social media. However, an obvious concern is breach of patient confidentiality. The risks, benefits and possible solutions are explored in this article.
Practices should have a robust policy around text messaging. A practice policy template for text messaging is included in Table 1.
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Challenges of text messaging
There remain valid concerns around the four ‘Cs’:
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Consent
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Confidentiality
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Children/young adults
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Content of text messages.
Robust safeguards, addressing these four key issues, are fundamental to safe and effective text messaging.
Consent
Consent should be explicit, and obtained prior to initiating text messages. An ‘opt out’ policy is unacceptable. You should text only when patients understand the benefits and risks of text messaging. It is important that the inherent risks are recognised, understood and mitigated by both patients and clinicians. Simple possession of a patient’s mobile phone number is not consent!
Consider how to inform your patients that text messaging is available. Posters, noticeboards and websites are valuable tools. Consent, once obtained and valid, generally does not require periodic review, provided the purpose is unchanged. An example of a consent form for text messaging is available.4
Confidentiality
The GMC acknowledges that most communication methods pose risk of interception. Clinicians should “take reasonable steps to make sure the communication methods you use are secure”.2 Clinicians should be mindful that persons other than the patient may access the text. Text messaging is inherently insecure: texts are transmitted on a public network and may be read by others, even on a locked smartphone. The clinician is not responsible for the text message once the patient has received the text. Patients should be encouraged to password protect their phones, and “read then delete” clinical texts.
In general, texts should not be sent to children under 16 years of age. Young people aged 16-17 years may consent to receive text messages. It is especially important to verify the phone number, as young people may frequently change mobile phones, or use a parent’s number. Carefully consider the content of text messages to young adults, in whom inadvertent breaches of confidentiality may easily arise (friends/parents access phone).
Content of texts
Some information is especially sensitive. Sensitivity is not determined solely by the type of information (eg. clinic appointment), but requires a judgment as to the impact if the information was misused. Text messages should not contain highly sensitive information.
Sexual health and mental health issues are highly sensitive. Discuss and agree with the patient what information may be texted: eg. appointment reminders, vaccine recall or investigation results? A correct approach to texting patients is suggested in Table 2.
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