Is It Appropriate to Text My Patients?

Almost everyone’s mail is clogged with junk mail. And avoiding scam and robo-calls has made phone communication a headache.

As a result, many people now prefer text messages to emails and phone calls. According to the website Text Request, each American sends and receives an average of 94 text messages per day.*

Many ND practices are also making the switch to text messaging—at least for appointment reminders.

This raises the question of how to exchange text messages with patients without crossing boundaries or creating HIPAA or other issues. A HIPAA-compliant EHR is a good start. The system should require logging in for HIPAA-protected information and opting in for appointment reminders.

According to defense attorney Mandi Karvis, the best approach will depend on the circumstances and nature of the intended communication. As guidance, Ms. Karvis offers the following legal insights about texting patients for naturopaths to consider:  

While patients and doctors alike may appreciate the convenience of texting, the more frequent the communication the more likely it is that a boundary will be crossed. For example, while the conversation may begin being strictly related to a simple task such as confirming a patient’s appointment, it can easily evolve into something else entirely. A casual “thank you” or “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.

Absent 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 should the patient experience 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 a treatment-related complication and, in the moment, you joke about using that same treatment again, it might seem funny. Nevertheless, this comment could later put you in a bad light with a jury.

In addition to boundary issues, text communication with patients can also cause privacy/HIPAA violations. Pursuant to HIPAA regulations, 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. There are several secure text messaging applications available for doctors to use for substantive conversations about patient care.

Lastly, 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.


ND Insights is published for NCMIC policyholders. Articles may not be reprinted, in part or in whole, without the prior, express consent of NCMIC. Information provided in ND Insights is offered solely for general information and educational purposes. Names and events are created for illustrative purposes only. It is not offered as, nor does it constitute, legal advice or opinion. You should not act or rely upon this information without seeking the advice of an attorney.

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