What are your thoughts on proposals that physicians should communicate with their patients by text?

Joshua A. Broghammer, MD

“Administrators can improve the patient experience, but we have to make sure it also improves the physician experience. Does it lead to better patient care? This job doesn’t really leave you 24/7, so this could help fuel burnout and make it more difficult for us to get our work done.

Patients also don’t understand that urologists are actually surgeons. They expect an almost immediate response to texts, but we’re in the OR [operating room] for hours on end. Without any real data [showing] that this improves anything, it just makes us too accessible.

Texting appointment reminders is fine, but what can you safely send? You have to make sure your messaging service is HIPAA [Health Insurance Portability and Accountability Act) compliant. Someone changes their phone number, hasn’t updated it, and you send out health information. How can you confirm the right person gets the message?

It’s another push by outside players to make physicians more accessible, as opposed to a physician-driven component to improve patient care.

I just got a MyChart message saying, ‘Now texting your physician’s office is as easy as texting your friends.’ Currently, that means texting my nursing staff, but with the worker shortages even that could create an overload from excess communication. Other questions: billing-wise, where does this leave us? What other business allows this much access in terms of being able to text a professional directly? I think our medical portal probably meets the need.

I don’t know what the benefit is.”

Joshua A. Broghammer, MD

Kansas City, Kansas

David Sisul, MD

“It hasn’t been propagated at my hospital. I don’t know any providers at my hospital who text with patients, although I know other urologists who do.

It seems intrusive for the provider. That would be my impression if I were asked to do it. Of course, the patient would have to agree to it and be interested in opening that line of communication.

The hospital texts patients with appointment confirmations and reminders, so that’s commonplace. As for provider and patient communication, it would be intrusive, at least with my practice, because I’m essentially a solo provider. I have a partner but we don’t share calls or patient responsibilities so there’s no one covering for me. Even though I don’t take calls for my hospital, my hospital calls me all the time. The ER [emergency room] calls if a patient ends up there with urological issues because I’m the urologist who works there. That’s the nature of my practice. So since I’m sort of always available, making myself more available isn’t something I’d be interested in.

If I were in a practice with 30 urologists, I would understand the expectation to respond to patient text messages. It’s reasonable in that sort of practice. So it’s practice specific is my answer.

I’m not afraid of being inundated during working hours. I’ve been working at my hospital for 6 years, so I understand the nature of the area. I don’t work in a large population center where you’ll see more volume. I know my volume and the amount of inquiries my patients have. So I wouldn’t be worried.”

David Sisul, MD

Blackfoot, Idaho

Robert Fleischer, MD

“I’m in a unique situation because I work part-time at 2 different institutions. There’s no institutional policy I am aware of for physicians to text patients. I have developed communication patterns over the years, determining what meets the patient’s needs with safe and effective care without miscommunication that can result in mistakes.

Personally, I don’t text with patients, yet there are a number of patients, particularly those at higher risk, to whom I give my cell phone number and tell them to call me if they have issues. I never suggest texting.

If somebody has a problem, I want to know about it. Going through my staff is always better. With so much information coming through, you’ll get numb to it. You’ll start getting texts about what someone heard on the news or asking whether they should keep an appointment. I want those to be screened by my staff. Patients can’t tell what’s important or not. I want to be immediately available for the important things. My office staff can call me anytime, anywhere for anything that’s important. They know that.

Trying to figure out over the years how to lessen the chance of problems while serving the patient’s needs is a fine line.

You’re talking to somebody who’s never been on Facebook, Instagram, or TikTok. I hope to use technology for my benefit, to make sure patients have access to help, but that shouldn’t be directly from me most of the time.”

Robert Fleischer, MD

Cooperstown, New York