Text messaging in primary care settings

Recently, Mrs. Henderson brought her infant son to a local pediatric practice for a checkup. The doctor handed her a slip of paper to see a specialist for a consultation, but it was misplaced. The next morning, she called to ask for the information again, but the first three attempts were short-circuited by busy signals. When she finally got through, a busy receptionist put her on hold. While waiting, Mrs. Henderson kept one hand on the phone while using the other to feed her son breakfast. By the time the receptionist came back, Mrs. Henderson had hung up because oatmeal was now dripping from the ceiling.

Here's another version of how this scene could have gone: Mrs. Henderson uses her cell phone to send a text message to the doctor's office, requesting the contact information. A short time later, during a brief lull, the doctor's office replies to her message with the complete contact information. While her son is napping, Mrs. Henderson retrieves her text message, and with a click of a button, dials the number to schedule an appointment.

Why is this simple and obvious solution not a more common option for more practices?

Based on recent statistics, it appears that Mrs. Henderson is not the only parent who could use text messaging (TM) to simplify her life. In America, 64% of mobile phone subscribers are already active users of TM; up from 41% in 2006 and 25% in 2005.¹ By the end of 2007, the number of text messages sent every month exceeded 48 billion, a 390% increase over the 2005 rate.² Thirty percent of American adults texted in the past week.³ Parents increasingly utilize TM to stay in contact with their spouses and children, schedule babysitters, and arrange play dates.

TM involves sending a short message (limited to 160 characters) to a cell phone number, or short code (ie, a five-or six-digit number used for convenience instead of a 10-digit phone number). Compared to phone calls and voicemail, TM has many advantages. Text messages reach their destination instantly, never get cut off or misunderstood because of bad reception, and can be easily accessed even in noisy, crowded places. TM is well suited for sending simple instructions, directions, or even Web site addresses. In fact, hyperlinks can be embedded directly in a text message, and Web-enabled phones can then link to the site directly from the message.

As a communication format between doctor and patient, TM can provide a win/win situation. The doctor's staff can send standardized messages during "down time," which patients will receive without playing a game of phone tag. While TM is not meant to replace traditional means of communication, it may represent an important new adjunct.

In general, while fewer than 5% of adults are currently able to communicate electronically with their medical providers, the majority indicate their preference for medical practices that offered the option.⁴ When asked, 62% of adults said that electronic communication would influence their choice at least to some extent.⁴ Additionally, 75% indicated they wanted to schedule appointments electronically.

Further, the preference for electronic communication is only likely to increase as today's pre-teens and adolescents become tomorrow's parents. Surveys suggest that at least 50% of 13-to 24-year-olds send or receive text messages in any given day.⁵