To Text, or Not to Text?

Communication is an essential part of patient care, be it a physician’s interaction with a patient or family member, student, or medical staff member. It is an accepted fact that most medical errors stem from miscommunication. Traditionally, medical communication was predominantly through phone calls, direct conversations, or illegible physician notes. In the present day, communication is largely electronic and digital. One would be tempted to assume that the use of such advanced technology would not only simplify but also enhance clinical communication and improve overall patient care. Does it?

A recent editorial by Norfolk et al describes the trends of electronic communication as well as text messaging in the nephrology community. The authors identify the advantages of asynchronous communication (where the communicator and recipient are not engaged simultaneously, either in person or over the telephone) and highlight the high efficiency of text messaging. The benefits of rapid exchange of information via text messaging could further translate into more efficient communication between dialysis nurses and nephrologists, obviating delays in response. This is especially vital in the care of ESRD patients in dialysis units, since the nephrologist may not always be available in person for clinical decision-making. Furthermore, the authors illustrate limitations of text messaging, such as privacy violations due to third-party providers, lack of confirmation of delivery, dependence on quality of cellular networks, and the risk of medical errors due to misinterpretation of abbreviations or typing errors. The authors suggest strategies to maximize the benefit of this technology while maintaining patient security, by developing policies regarding standards of communication of patient identification, education of the medical staff, implementing the practice of confirming the receipt of messages, and using password-protected company’s devices rather than personal mobile devices, to name a few.

Although the general use of cellular devices has been rampant over the past few decades, its advent into the field of medicine is only recent. Data on the impact of text messaging on various facets of medical practice are sparse. While some studies have shown a positive impact of text messaging on patients’ behavior and preventive health practices (smoking cessation, weight loss, diabetes control) and also on increasing adherence in patients with chronic diseases, a recent study concluded that when compared with traditional paging, web-based text messaging resulted in an increase in physician interruptions. In conclusion, to text or not to text: still remains in question. When in doubt, just call.

Ritu Soni, MD
eAJKD Contributor

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