The need to act prudently and take extra care when conveying electronic messages to patients was the take-home message during an education session at the 2017 AMA Annual Meeting.

Ingrid Hubbard Reidy and Mike O’Neill—both risk managers with the physician-owned, Chicago-based medical liability insurer ISMIE Mutual Insurance Co.—discussed appropriate use for electronic communications and offered real-life examples when such exchanges had faltered.

Reidy, ISMIE’s assistant vice president for risk management, program development and technology, described one such instance. A physician engaging in an ongoing texting dialogue with the mother of a young patient instructed her to stop worrying about her child. “You’re crazy,” the physician texted the parent. “Your child doesn’t have anything wrong.” Subsequent to those messages, the child was diagnosed with leukemia. The patient’s family successfully sued the physician for delayed diagnosis, using the electronic communications as a basis for the suit.

“Recognize that anything said [electronically] is out there indefinitely and subject to discovery,” said Reidy.

O’Neill, ISMIE’s assistant vice president for risk management operations, added a sterner word of caution from a medical liability perspective.

“If you’re questioning whether you should or shouldn’t [send an electronic message], you probably shouldn’t,” he said.

Sensitivity to patients should be an overriding concern in all communications with them and, in particular, in electronic communications, Reidy and O’Neill said. And it should not matter whether patients act accordingly.

Reidy gave as an example an overweight patient who complained on social media about sitting in a broken chair in his physician’s office. An aggrieved nurse who worked for the physician took matters into her own hands and responded on social media. “The best part of the 427-pound patient (literally) who broke it is that they complained about our dangerous furniture,” she posted.

Such communications damage a practice’s reputation, Reidy and O’Neill said, and they necessitate training of practice staff to ensure that everyone in the office knows and adheres to policies regarding electronic communications with patients. In most cases, the ISMIE executives said, staff should not be communicating with patients electronically, except perhaps to confirm appointments.

Among other items of advice, Reidy and O’Neill also recommended:

  • Using only business numbers and email addresses when communicating with patients.
  • Ensuring that no one has access to physician login and password information.
  • Formalizing an office policy on electronic communications in writing and reviewing it yearly, as technology continues to change.
  • Discussing sensitive information with a patient in person—or on the phone. Reidy described the case of a patient finding out she had a recurrence of cancer by checking her secure patient portal before her physician had discussed test results with her. While no malfeasance had occurred, it was, Reidy noted, far from the ideal way for the patient to learn about her condition.

Read more news coverage from the 2017 AMA Annual Meeting.

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