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Some electronic health record (EHR) systems do not offer integrated texting apps, which can lead to the use of texting apps that require a separate process to transfer texts to the patient record. Unfortunately, text messages frequently do not find their way into the record.

Text messaging often serves as a distraction. And distractions, in general, increase the risk of patient injury.¹ Whether work related or personal, texting generally involves cognitive, visual, and manual tasks. Like phone calls; pages; alarms; and colleague, patient, and patient family requests, text messaging increases the already immense amount of information received and processed during patient care.²

Texting can blur traditional patient-physician boundaries. The loosening of social inhibitions in the online environment often allows people to behave differently than they would in person, a phenomenon known as the online disinhibition effect.

More than 68,000 Americans died of opioid-involved overdose in 2020—a 37.6 percent increase over 2019, and the largest yearly increase in opioid-involved overdose deaths in two decades.^1,* A total of 16,416 (23.9 percent) of those deaths involved prescription opioids.¹ Approximately 21 to 29 percent of patients prescribed opioids for chronic pain misuse them,² and between 8 and 12 percent of patients prescribed opioids for chronic pain will develop an opioid use disorder (OUD).² It’s no surprise, then, that overdose death involving opioids is referred to as “a public health emergency” and an epidemic.^3,4

Alone or in combination, various patient, physician, and healthcare environment issues can contribute to patients being perceived as difficult. And, since physician burnout can both increase the incidence of challenging patient encounters¹ as well as result from these encounters,² reducing physician burnout stressors and reducing the factors contributing to physician-perceived difficult encounters could help mitigate both.