When engaging in patient care and treatment, it is important to consistently weigh the risks and benefits of text messaging and determine whether it is appropriate under the circumstances. As the case studies in this article show, careless text messaging practices in the healthcare environment can contribute to patient injury and substantially complicate the defense of malpractice claims. While taking advantage of improvements in efficiency and patient safety that text messaging can bring, it is important to recognize and manage privacy, security, patient safety, and professional liability risks. Using the strategies in this article can reduce the risk of medical errors, malpractice lawsuits, and HIPAA/HITECH violations caused by texting.