Tuesday, August 31, 2010

The Texting Shrink


I like texting. It's a fast and efficient way to exchange information, and I'm a bit prone to yakking, so this allows for a no-nonsense exchange without all the gabbing about how the kids are doing or the latest on someone's ingrown toenails, or the usual assortment of small talk items. Running late, order my salad. Yes, Bobby can get a ride home with us. Or, if you're Roy: "do you have triple sec for the mango margaritas?" Roy makes surprisingly good mango margaritas without using any triple sec. Just so you know-- and I don't mean to brag-- I'm fast with the thumbs.

I text with patients as well. Do other psychiatrists do this? It works well for "Need to cancel my session this week, see you next week." Or "Running 10 minutes late, traffic." Once in a while I'll even text a reminder to someone who misses appointments frequently. I was happy to hear that there is a dentist in town who also sends text message reminders.

Here's the problem with texting patients:
People have taken to texting me with problems. "I feel horrible and like I might want to end it all right now." (This did not really happen). I've done a few back and forths and realized that I'm not good at psychotherapy via text. Usually problem texts get met with "Come in at....." and if .... is not Very Soon, or if the patient says that's not good, I call, or text "call me." I've been texted insurance information, drug reactions, appointment changes, negative biopsy results, "will you call refills in to my pharmacy?" and most notably, "Your office door is locked" after I haven't responded to the knocking, only to find my patient sitting on the hallway floor.

What's good about it? Somehow it feels less intrusive than a phone call, and the time taken up is more predictable. I'm prone to ramble and so are many of my patients-- texts messages take seconds and phone calls can take minutes and involve many phone-tag back-and-forth exchanges. When someone texts their pharmacy number, I can click on it and get through--if it's on voicemail, I often have to re-listen when I have a pen available, and often the number is at the end of a long message. It seems to me that texting is no less documentable than a phone conversation, so I can't come up with any legal reasons it's not kosher.

What's bad? I have taken to telling patients that while I'm happy to try to negotiate appointment times via text, or "running late" messages, that it's not a good way to negotiate problems-- for drug reactions and symptom changes, we should start with the phone. My biggest concern is that if I'm on vacation, there's no way to set a coverage text message, and my voicemail has the names and numbers of covering doctors. I've been pretty clear with people that I'm not blowing them off, and that if they don't get quick reply to a text message, they need to CALL the office.

What do you think? It's a different take on the shrink when there's nearly instant access a good deal of the time.