Editors' note: Patient names have been changed to protect privacy. The opinions expressed in this article are the author's own.
A new text flashes across my phone: "Simon is screaming." It’s Saturday, 9:13 p.m. My kids are fast asleep and I’m out with my dog. I open the full message: "Hi Dr. Bottino. Simon is screaming. He has a red bum. What do you recommend? I reply: "Hi, how’s he doing besides the red bum?"
I received 2,097 texts from patients in 2018. They sent me pictures of rashes, swollen gums, family pets and graduations. They sent videos of babies breathing noisily and taking their first steps. I sent 1,969 texts in 184 threads: 26 in Spanish, 1 in Amharic and 1 in Haitian Creole. Mési — thank you — Google Translate!
Patients sent emojis, selfies and GIFs. They sent turkeys on Thanksgiving, heart-shaped stethoscopes on Doctor’s Day (who knew this existed?) and my favorite, Darth Vader on Father’s Day.
I’ve been sharing my cellphone number since I started my practice in 2009. Most of my paid clinical time is spent rushing through 15-minute visits and slogging through electronic paperwork. With texting, the rush disappears. Patients can text me when they want and there are no boxes to tick. I can answer questions, put worried parents’ minds at ease and prevent unnecessary ER visits. It feels invigorating, the opposite of burnout.
Patients can text me when they want ... I can answer questions, put worried parents’ minds at ease and prevent unnecessary ER visits.
Expectations about texting between doctors and patients are, at the moment, low. But if and when texting becomes protocol, rising expectations may bring tyranny. For now, at least, it’s personal. At the birth of a sibling, patients send me photos of their new addition. In illness and death, we remain connected.
One of my first patients was Brian, a 9-year-old boy with a tiny piece missing from one of his chromosomes. Brian was blind. He depended on a gastrostomy tube for nutrition and a wheelchair for mobility. When we met, I told his parents, “I know Brian sees lots of doctors. But if I can help with anything, just text me.”
Brian’s father texted me one Saturday morning: Brian was not feeling well, at the hospital. I called. Brian, now nearly 20, was found at his respite center unresponsive and pulseless. Despite CPR, Brian suffered massive brain swelling requiring full life support. His father texted me that afternoon. They had pulled the machine off and Brian passed away. His funeral was private, but that day his father sent me a picture of the program flyer. I replied: "Brian will always be loved and missed. If I can help with anything, just text me."
I share my number with the parents of nearly every patient I see. This includes all 769 of my own patients, plus hundreds more from urgent care visits. Fewer than 20 percent of my patients texted me in 2018. Of those who did, 80 percent sent me fewer than 20 messages, while 3 percent sent me more than 100.
I sometimes worry that the thousand or so patients who have my number will all text me at once.
One of my patients, a 4-year-old girl named Rae, had a large tumor growing on her kidney. Despite years of treatment, the tumor grew back and spread everywhere. I visited Rae as she lay dying in her hospital bed. She was now 9, but so thin and without hair, she looked much younger. I asked her mother if Rae might like to FaceTime my daughter. She said yes, and for the next half-hour, my daughter, 5, (and son, 3, in the background) took Rae on a guided tour of her Hatchimals and Littlest Pet Shop playsets. I told Rae’s mother, “I know Rae is tired, but if she would like to FaceTime again, just text me.” We did, several times more, before Rae died. At her funeral, Rae’s mother kissed my daughter and thanked her for bringing Rae so much joy.
The Journal of the American Medical Association has reported that “texting to communicate health information is neither explicitly prohibited by [the U.S. Department of Health and Human Services] nor illegal in the United States." Still, my family and colleagues often question my work-life balance. I sometimes worry that the thousand or so patients who have my number will all text me at once.
I bumped into Rae’s family one evening outside a local diner. Rae’s mother asked me about my kids, and I showed her some pictures on my phone. I told her I think of Rae often, and her eyes filled with tears. “Maybe some time,” I said, “your family can stop by our home for cookies and coffee. We live just up the street.”
“Yes,” she replied, “I would like that very much. I’ll text you.”