• nerve block
• outcome assessment
• health care
• technology
• outcomes
• acute pain

To the Editor

We wish to thank Drs Pai and Lai for their thoughtful comments1 on our recent report describing the use of an automated text messaging system for routine postoperative follow-up of patients who receive peripheral nerve blocks.2 The high patient response rate to our text messages did indeed exceed our expectations, and we should point out that this rate was consistently high across a diverse patient population.

We agree with Drs Pai and Lai that, unlike unsolicited ‘telemarketing’ phone calls which are readily ignored, a text message is quite likely to be read by the recipient. Unfortunately, this may change as the telecommunications industry implements new filtering and blocking technology to reduce the burden of unsolicited text messages on consumers.3 We encourage our colleagues who may be interested in automated text messaging to pay close attention to evolving telecommunications industry guidelines.

With regards to the importance of live clinician–patient interactions and the educational value of these encounters in resident and fellow training, we agree with Drs Pai and Lai. However, we are also cognizant of the ever-increasing administrative burden faced by trainees and practicing clinicians in modern healthcare and are concerned about the high prevalence of burnout among anesthesiologists. We should reiterate that the automated text messaging system that we describe is not intended to replace clinicians. Since a large proportion (38%) of patients require additional clinician follow-up based on their text messaging responses, there remain plenty of opportunities for trainees to learn postoperative evaluation and for clinicians to interact with their patients.

Ultimately, patients are the best judges of their own satisfaction, and none of our patients reported dissatisfaction with the automated text messaging system. However, patient satisfaction is influenced by many factors, and the mode and quality of postoperative communication may be among them.4 Our experience has shown that automated text messaging can effectively augment communication with patients after surgery, it is simple and direct and allows the patient to respond asynchronously unlike a telephone call. We believe that automated text messaging represents a valuable option but support the availability of a wide variety of modalities that clinicians can use to customize communication with their patients.