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I do family medicine 4 days a week. What do you do if a patient has your number and texts you about worsening mental illness/suicidal thoughts. This patient now lives in a different state and says that they do not want to talk or see anyone else. Do you respond and work through it with them via text messages? Schedule A telemedicine visit? And this is happening while your on vacation? Just a current scenario I am in and would like some advise. Thanks. 

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A. Patients should not have your personal cell number

B. DOCUMENT all contact in the chart with times, dates, etc. Quotes or printed screens of texts. 

C. Call them if suicidal with preparation to patch into 911 wherever they live now. Find someone to refer them to in new city and do provider to provider call to review history. 

D. Once this Is resolved, make clear boundaries in writing by certified mail that texting is not private, secure or an acceptable form of pt/provider communication and then get a new phone number or block them from yours.  Also clarify that you cannot tx by phone or out of state and end the pt/provider relationship on that basis. 

E. Make And keep stronger boundaries to prevent repeat of this

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Thanks for the reply. The only reason this patient has my number is due to belonging to the same church who has a roster with  everyone’s phone numbers. I do not give out my number to patients. I guess I will need to delete my number from said roster. 
I will start working on those things listed. 

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Being a medical provider can be a hard role.  The boundaries between private life and professional life can be uncomfortable, especially in a small town. But in all these years I have learned that setting and keeping those boundaries is safest even if uncomfortable. 

I try not to give anyone my cell number where it could be published or easily located.

We still have a landline (long weird story) and I tend to give that number out when needed. We never answer that phone and it goes to a machine.  

We are also unlisted and I have a VERY minimal digital footprint. No facebook, no snapchat, no instagram or whatever. 

Wouldn't matter if I had another profession - wouldn't be on social media anyway. 

Stay safe and I hope that patient gets the care they need.

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the cat is out of the bag....  you must deal with this issue now

1) call them

2) tell them that you are worried and not in the position to help

3) assess rather they are currently SI - with a VERY LOW threshold to call a safety check from local police

4) make sure they have a crisis hotline number available to them

5) document the living heck out of this

6) unless absolutely 100% sure they were safe I would ask the local police to perform a wellness check



block their number

block all texts from unknown numbers

block all calls from unknown numbers


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