Electronic communication with patients
Email is an attractive way for patients to communicate with the practice, and the demand for such a service will undoubtedly increase over time. Safeguards are required in order to preserve patient confidentiality.
Only appropriate matters should be dealt with via email exchanges, eg appointment scheduling, ordering repeat prescriptions and obtaining test results. All emails to and from the patient should be included in the patient’s medical record.
It is important to:
- Ensure that there are appropriate levels of encryption.
- Liaise with your IT provider to ensure that appropriate safeguards are in place and information on the clinical system remains secure.
- Have an automated response indicating that the email has been received, when the patient should expect to receive a reply and a recommendation that they should contact the practice directly if the matter is urgent.li
- Monitor email enquiries at regular intervals and ensure that they are promptly brought to the attention of the relevant person.
- Respond in a professional manner and, in particular, avoid “textspeak”.
- Ensure that there is a mechanism in place to deal with enquiries that arrive whilst you are on leave or away from the practice.
- Ensure that email communication is from a secure NHS email address and not from a private email service provider.
Medical Protection has dealt with a number of cases where information has been picked up by the wrong person, often because of misdialling or out-of-date fax numbers or where the information has not been received at all. Doctors are advised to:
- Only use fax machines to send sensitive data if it is absolutely necessary to do so. For example, to send an urgent referral or when no other means of requesting the referral is available.
- Ensure any fax machines are only accessible to authorised staff, and are placed in a secure location.
- Check with the intended recipient before sending that incoming faxes are only picked up by authorised staff, and ask them to confirm when it has been received.
- Ensure confidential faxes are not left lying around by the recipient.
- Use pre-programmed fax numbers wherever possible, rather than hand-dialled numbers, to avoid the risk of misdialling a number when sending sensitive information.
- Send a cover sheet along with the fax, containing a confidentiality statement.
- Include the minimum amount of personal information necessary in the fax or, where possible, anonymise the document or use a unique identifier.
Many GP practices are signing up to using a text messaging service to inform patients of appointments, flu vaccinations, etc. However, do not assume that just because you hold the patient’s mobile telephone number on the patient’s record, they have provided consent for text messages to be sent.
During an appointment or other communication, ask the patient if he/she would be happy to receive a text message via mobile phone, eg for an appointment reminder. The patient’s consent or refusal must be clearly recorded on the patient’s computer record where it is easily visible. Patients who consent should be advised of the importance of informing the surgery of any changes to their contact details.
The text message would be considered part of the patient’s medical records, hence it is important that the consent for the text message is recorded in full, as well as the date and time that it was sent and the content of the message. Any response received should also be recorded in the patient’s record in the same way.
What information is not appropriate to send by text message?
Be careful about the information contained in text messages; in general terms, text messaging lends itself to sending out generic reminders to specific target groups. However, it is not an appropriate way to deal with clinical queries and patients should be made aware of this.
Practices should not rely on text messaging alone in relation to the issuing of reminders; it should simply form part of a wider strategy. There is a risk that patients may respond to the text and seek other information (for example, clinical advice).
Use of social media
The GMC’s guidance Doctors’ use of social media
establishes the standards expected of every doctor practising in the UK. The guide details the principles of conduct for using social media and explains how doctors can put these principles into practice.
Social media channels offer many new opportunities to communicate with patients. Many of these channels represent effective outlets to promote healthcare, but they also present many new challenges for healthcare professionals.
Patient confidentiality is a key issue – the very public nature of social media means doctors must take care to avoid unintentional disclosures. Although many online accounts provide privacy settings for users, seemingly innocuous comments can be shared widely and cannot be revoked.
Right to anonymity
Whilst you may usually choose to remain anonymous, the GMC advises that if you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name. Material written by those representing themselves as doctors is likely to be taken on trust, and may reasonably be taken to represent the views of the profession more widely. Content uploaded anonymously can in many cases be tracked to its origin.
Ensuring patient confidentiality
It is important to maintain patient confidentiality when using social media – even if you do not identify yourself as a doctor you must still be careful not to share identifiable information about patients. Many doctors use social media sites that are not available to the wider public; these can be useful to find advice and information on areas specific to your profession. However, you must still be careful not to disclose any identifiable information regarding patients.
It is also important to remember that patients may be identifiable through information other than just their name.
Maintaining patient confidentiality online is not strictly limited to comments and messages – most platforms also contain content such as photos and videos. If you intend to take pictures for a professional purpose, make sure you obtain proper consent from any patients or staff who are present as well as someone in a supervisory role.
Maintaining boundaries with patients
When discussing the boundaries with patients via social media, the GMC states: “There may be instances where a patient contacts you about their care or other professional matters though your private profile. If this type of contact occurs you should indicate that you cannot mix social and professional relationships and, where appropriate, direct them to your professional profile.”
Responding to online feedback
The way you respond to comments can have a huge impact on the way the healthcare profession is perceived. Regardless of the size of the organisation – it might be a hospital, general practice or walk-in centre – responding to patient feedback often requires the same principles. NHS Choices has established some guidelines for responding to patient feedback:
- Respond to all comments, good or bad, as it shows you listen
- Welcome all opinions and try not to be defensive if they’re negative
- Do not use the same stock response to each comment. If anything, this looks worse than not responding at all
- Remember, your response will be seen by everyone who reads your practice’s comments, not just the original commenter. Your reply is a good opportunity to market your practice.