Perhaps a text message from the doctor's office seems like inadequate or impersonal post-operative care, but that method of contact might actually help patients recover faster after surgery, new research suggests.
The study looked only at women who had breast reconstruction after mastectomy but raises the possibility that texting between surgeons and patients undergoing other surgical procedures might also be beneficial, said Dr. Roshni Rao of the University of Texas Southwestern Medical Center in Dallas.
In the study involving 102 women treated by one of two surgeons, one surgeon used routine postoperative text messaging while the other surgeon did not. In the texting group, patients texted the amount of fluid output from a surgical drain each evening, starting on the day they left the hospital. Monitoring the amount of fluid and removing the drain when it is no longer needed are routine parts of follow-up care.
After receiving the patient's message, the surgeon responded with instructions to continue with standard drain care or to come to the clinic for drain removal or wound evaluation on the next working day.
Patients operated on by the other surgeon received a routine appointment to come to the clinic one week after leaving the hospital.
Over 30 days, women who exchanged texts with their surgeon made significantly fewer clinic visits and phone calls. Text messaging also reduced the number of days the drain was needed. On average, the drain was removed nearly three days earlier in the text messaging group.
“That was surprising,” Rao said. “If you've ever had a drain, you do what you have to do, but it's not pleasant.”
Texting may have improved patients' adherence to medical advice by providing an easy, speedy means of monitoring and recording fluid output, Rao said.
“The biggest thing is, this is how people communicate now,” she said. “The medical establishment needs to find ways to use this technology with appropriate boundaries and in the right situations.”
The research was published in the July issue of Plastic and Reconstructive Surgery.
If lawful, texting back and forth with doctors could be beneficial because “not every patient question requires an office visit or a phone call,” said Dr. Michael Nusbaum, who was not involved in the study.
Secure text messaging “permits rapid communication, potentially reducing delays in treatment, he added.
Despite potential advantages, texting between doctors and patients has been slow to catch on. Obstacles include concerns about confidential patient information and physicians' privacy.
The way he interprets patient privacy laws, collectively referred to as HIPAA, “Text messaging between a patient and a provider over standard text messaging systems is a HIPAA violation and is subject to a fine,” said Nusbaum, who developed an app called MedXCom Patient to facilitate communication regarding patient care.
“Any text messaging between providers and patients must take place over a secure system in which the messages are encrypted and the system is secure and HIPAA compliant,” Nusbaum said, adding that MedXCom is text-enabled and meets those criteria.
Rao agreed privacy is a concern but said the legalities are not clear because HIPAA has not kept pace with technology.
“There's not really a lot of guidance yet,” she said.
In the study, patients used text messaging to send only the requested information during specified hours, and cell phones were password-protected.
Looking forward, integration with electronic health records is a technological challenge that needs to be addressed if doctors and patients interact via text messaging, Rao said.