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The medical record is not the forum for blame, personal attacks, or finger pointing.¹ Text messages relating to patient care should be considered part of the medical record (whether they are transferred to it or not), and the same rule about appropriateness of forum should apply. If something about patient care is important enough to be texted, it should be included in the medical record. If it is something that does not belong in the medical record, then it should not be texted. It seems clear that the members of the healthcare team texting each other in the following case study did not expect their text messages to be used against them in the malpractice lawsuit.

Texting presents unique communication challenges. The brevity and casual nature of text communication that makes it convenient can also make it inappropriate in a healthcare setting. One key to using text messaging in healthcare is to know when an in-person or telephone conversation is necessary. Telephone conversations allow for important information to be exchanged with greater ease, and a more natural opportunity for questions and responses.

Text messaging can provide quick, efficient communication between physicians and patients. In malpractice litigation, it can also prove physician attentiveness and responsiveness. However, text messages can complicate the defense of a malpractice claim, particularly if they are not integrated into the patient record. Consider how documentation issues unnecessarily complicated the defense in the following case.

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.

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.