Recommendations for patient communication via telephone and text message

• It is important to take steps to protect patient privacy when communicating with patients by telephone and text message.
• Offer patients a choice of communication methods - mail, email, telephone or text message - and ensure they are not disadvantaged by lack of access to technology. 
• Have clear policies and procedures in place for leaving telephone messages and sending text messages to avoid privacy breaches.

Protecting patient privacy when communicating with patients via telephone or text message is essential. A patient's confidentiality can be compromised simply by revealing that they are seeking medical care. Therefore, practices must have clear policies and procedures in place to guide staff on how to communicate appropriately.  

While you do not need specific consent to contact a patient by telephone, you should always be mindful of how much information is disclosed in a telephone or voicemail message to ensure privacy is not breached. You should specifically check whether patients agree to receiving text messages and this may be for direct communication from their treating doctor, or for practice communications, for example about health checks.   Always document the patient’s consent and preferences in the patient’s file and ensure it is updated if there are any changes.

This factsheet explores telephone and text communication with patients. There is a separate factsheet on email communication with patients.

Obtain and manage contact details when patients first register with the practice. Ask them to provide their preferred method of contact – whether by mail, email, telephone, or text message, making sure all details are up-to-date. It’s important to offer all options so patients can choose what suits them best.

During consultations, especially when there is a possibility of needing to recall the patient urgently (e.g. due to concerning test results), confirm their most appropriate contact number and communication preferences. This proactive approach helps ensure timely and appropriate follow-up. 

Telephone calls and leaving messages 

Leaving messages for patients can be tricky due to privacy concerns.  If you are unable to reach a patient directly, and they have consented to receiving messages, you may leave a brief voice or text message.

If you do leave a voice message or send a text in accordance with the patient’s preference, or someone other than the patient answers the phone, leave only a short message asking the patient to contact you or the practice.  No detailed information or results should be included in the message; just a name and return contact number. You should then document this in the patient’s record.

Sending text messages

Medical practices are increasingly using text messages for recalls and reminders due to several advantages:

• Patient convenience: patients often prefer receiving messages on their phones and are more likely to respond promptly to a text message than a letter.
• Efficiency: mobile phone numbers tend to be more reliable than other contact details as they are less likely to change, go directly to an individual and text message provides instant communication. 
• Cost and time savings: sending a text message is more economical and faster than mailing a letter.
• Technology integration: many electronic health record systems and online booking platforms provide an easy way of sending and capturing text messages. In some systems there may also be an option to receive a ‘read’ stamp, confirming the patient has read the message.

If the whole or part of the purpose of the reminder text message is to advertise or offer goods or a service at the practice (such as a flu shot), you must comply with the Spam Act (Cth) 2003 and the Privacy Act (Cth) regarding direct marketing. This means:

• You must obtain the patient’s consent to send them text messages for this purpose. 
• The message must clearly and accurately identify the organisation that sent the message.
• Accurate contact information for the organisation must be included.
• There must be a clearly presented option to unsubscribe.

Having clear policies and procedures for contacting patients, including preferred methods of contact and obtaining consent, helps set expectations for both patients and staff. The policy should outline:

• The methods your practice uses to communicate with patients and under what circumstances.
• How patients can best contact the practice or individual doctors depending on their needs. 
• Staff responsibilities for managing incoming and outgoing communications and to document any messages appropriately. 

To encourage consistent use of the system in relation to text messaging, the policy should address:

• who is authorised to send, receive and respond to text messages
• how messages are recorded in the patient's electronic medical record
• what information is appropriate to include in a text messages
• how patient consent is obtained and documented
• whether text messages may include offers for goods or health services
• how patient mobile telephone numbers are verified and kept up to date. 

A staff policy can also support internal consistency by guiding training on triaging messages and documenting communications appropriately.

1. Obtain and document consent

Your practice should document the patient’s preferred contact details when they first join the practice.

If you use text messaging, you should inform patients that these are used as a reminder service for appointments and recalls. This can be done in the Privacy Policy and/or on the practice website. Just because patients have provided a mobile phone number does not automatically mean they agree to receive text messages for all communication.

Your practice should obtain the patient’s consent to receive text messages:

• in the patient registration form for new patients
• when confirming an appointment for existing patients
• through an online appointment or registration portal.

2. The patient's contact details should be checked on a regular basis

Routinely check with patients that their contact details remain current. Do this in a way that also respects their privacy. Ensure you also document any limits on the way the patient prefers to be contacted.

Where patients do not consent to be contacted by text messages this should be clearly documented and adhered to, to ensure that a privacy breach does not occur.

3. Limit the information contained in messages

All messages for patients should be limited so that the risk of sensitive information being accessible to anyone else is reduced. Messages should not contain sensitive health information such as a description of particular test results that need to be followed up or the results of such tests (unless the patient expressly consents to this). The message should simply request that the patient contact the practice, as well as indicate (where appropriate) the level of urgency.

Your software may allow the option to “send message” when checking results and correspondence and this sometimes is the most convenient option to communicate clinical information to the patient. If you use this feature, you must ensure the patient has consented to receiving specific health information via text or telephone message. Systems may be able to be configured to block messages if consent has not been given.

It is reasonable to send reminders about generic preventative screening tests (e.g. cervical screening tests, skin checks, flu vaccines) as part of a practice’s preventative care role. However, it is best not to include the detail for the reminder but rather refer generally to a repeat screening test and a message to contact the practice for more detail. Some systems allow you to send a link and the patient then logs in to obtain further details.

4. Implement a system for following up patients who do not respond

When recalling patients for test results the same principles apply to telephone or text as for following up any test results. The extent to which patients are followed up will depend on the level of urgency and the clinical significance of their test results. 

See Avant's Patient follow-up and recall factsheet for more information.

In the case of routine preventative health reminders, it is generally not necessary to continue to follow up patients as they may have made other arrangements.

5. Document all communication in the patient’s record

All telephone calls and messages should be documented in the patient's medical record. This should include the time and date of the call, and method e.g. voicemail message, text messages.  Many electronic medical record systems automatically log text message communications, including timestamps and message content. If your system does not do this, ensure staff are trained to manually document these interactions in the patient’s file.

Avant factsheet: Patient follow-up and recalls

Avant collection: Digital communication - what you need to know 

Office of the Australian Information Commissioner, Guide to Securing Personal Information 

Royal Australian College of General Practitioners, Text messaging in general practice

Royal Australian College of General Practitioners RACGP standards 5th edition 

Australian Communications Media Authority Avoid sending spam | ACMA

For medico-legal advice, please contact us here, or call 1800 128 268, 24/7 in emergencies.