On May 24, 2024, a new Code of Medical Ethics (KEL) was published, which ceases to treat telemedicine as an exception to personal examination, and recognizes it as a support, complement or extension of patient care, whose foundation remains personal contact (Article 9 KEL).
This change is relevant for hybrid medical care, combining in-patient visits with remote contact, especially among patients with chronic diseases.
Remote contact with the patient is already an integral part of care for most doctors in Poland. As many as 80% of them declare that they have at least once been in remote contact with their patient to supplement in-patient visits. The most common contact channels are SMS, email, commercial instant messaging (WhatsApp, Messenger) and medical communicators.1
Written contact with the patient has a number of use cases And it brings not only advantages. Care management from a doctor's perspective, but it is also effective in improving health outcomes among patients with chronic diseases such as diabetes, hypertension and heart failure.2
Despite the prevalence of written physician-patient contact, the current literature on telemedicine communication focuses mainly on face-to-face video visits, leaving a gap in training and education on chat-based interactions.
Therefore, in this article we will present a set of practices and examples on how to effectively transfer a conversation with a patient from the office to the medical chat, while maintaining professionalism, safety and empathy. At the end of the article you will also find useful materials for download.
Talking to the patient in the office and in the medical chat
To carry out an effective conversation with the patient through chat, it is necessary to understand the new context in which the doctor and the patient are. First, written contact is devoid of non-verbal language (gestures, facial expressions, tone of voice), therefore it requires new skills to read the emotional state of the patient and demonstrate the so-called digital empathy. Secondly, written contact is characterized by greater linguistic coherence and a better structure of expression, which makes it much easier for the patient to assimilate information. Thirdly, written communication takes place asynchronously, that is, the doctor and the patient are in different places, and the conversation can be distributed in time (the patient writes at one time, and the doctor writes back when he has the opportunity). From the presented differences follow recommendations for an effective and at the same time empathetic conversation in chat with the patient.
Preparing for a chat
The first step from which to start working remotely with a patient is to establish communication rules, such as the preferred way to address the patient, situations that require remote and personal contact, and how to deal with emergencies. An important point of discussion is also the legal restrictions in the case of choosing a channel such as SMS or a commercial messenger (we write more about this in this article).
Start a chat
The starting point is to determine the course of action depending on whether the conversation is about an acute or chronic condition or prevention, reminders or education. In the first case, it is crucial to pay close attention to the patient's emotional state and to strive for a synchronous exchange of messages (the shortest possible time intervals between the patient's message and the doctor's message). In the second case, the conversation can take place asynchronously and as factually as possible.
Knowing the patient's problem/collecting anamnesis
According to Article 42 (1) of the Law on the Profession of Physicians and Dentists The doctor makes a judgment about the state of health of a particular person after a previous, personal examination of him or his examination through ICT systems or communication systems, as well as after analyzing the available medical records of this person. In a conversation with a patient via chat, the doctor uses the same procedure for collecting anamnesis as in the office. Due to the limited possibilities of examining/seeing the patient, when diagnosing the problem, it is worth using in-depth questions, asking for clarification or sending photos/recordings of symptoms. Ready-made structured surveys are also useful for remote interview collection. If this is not sufficient, the doctor should decide to change the contact channel (e.g. to telephone contact or in-person visit).
Arrangement of proceedings
When prescribing management to a patient, it is worth knowing the three basic principles of effective communication of information in the chat.
Giving information a structure
To make it easier for the patient to read and assimilate information, it is good to give them structure. This can be done by dividing the text into points (1,2,3) and sub-points (a, b, c) or by graphically separating the most important information from the rest (e.g. using hyphens).
Using graphics
A message that contains the text itself has a message efficiency of 50%, while a message that contains text and graphics increases its effectiveness to 80%.3 Therefore, if possible, include graphic instructions (such as how to measure blood pressure or how to prepare for a test), graphics showing the effects of the medicine or the course of the disease.
Using the correct form of the verb
In chat communication, it is necessary to write messages in a comprehensive and specific way that does not leave the patient with questions (the so-called low context language4). Especially it is worth paying attention to the form of the verb. Instead of using the first person plural (e.g. “We will do a survey”), from which it does not follow who should arrange and perform the examination, it is better to write exactly who the action concerns (e.g.”Appointment of you for an examination at the clinic” or”Please do a blood count in the laboratory”).
Chat Summary
In the summary of the conversation with the patient in the chat, the basic question should be included whether all the recommendations and information are understandable and whether they require additional clarification. Since the doctor cannot read the uncertainty from the patient's non-verbal language, it is worth asking the patient at the end if he has any other questions or needs that have not been raised in the course of the past communication.
When talking to a patient's parent or caregiver (e.g. caregiver of an elderly person), it is also a good idea to ensure that all caregivers receive the information provided.
The summary should end with an indication of the next steps for the patient, including when and how the patient should consult in case of questions, abnormalities or for a follow-up consultation.
Digital empathy
During face-to-face interactions in the doctor's office, physician empathy is about understanding the patient's experience, connecting with his/her emotions, and responding in a caring manner. Empathy goes beyond mere courtesy or interest and requires active appreciation for the patient's way of thinking and emotions.5 Research shows that empathy improves patient experience, adherence to therapy, and health outcomes.6
Therefore, as medical communicators are used, in addition to providing correct, evidence-based information, it is equally important to consider the way in which this information is communicated in accordance with the emotional needs of patients.
Digital empathy therefore means understanding emotional states, and communicating and acting on that understanding through digital media and technology, such as chat.6 It is crucial in maintaining a trusting doctor-patient relationship despite the lack of direct interaction in the office.
Professionalism, that is, emoticons and the form of writing
Emoticons
In order to maintain the professionalism of the conversation and respect for the patient's communication needs and habits, the use of emoticons in medical chat should be more a reaction on the part of the doctor than his proactive action. If a patient uses an emoticon to depict their emotional state or to set the tone for their speech, the doctor may also include them in their messages.
Linguistic correctness
In contrast to the patient, the written communication of the doctor should be characterized by linguistic correctness.
Writing style
Capital letters in written communication on the part of the doctor can create connotations of orders, anger, shouting, therefore they should be used exclusively in the titles of messages for better structure and readability.
Time to respond
When writing with the patient, it is worth considering and respecting the different response rates.
Practical downloadable materials
Techniques and examples of digital empathy in patient chat [Download]
Checklista for an effective conversation with a patient in chat [Download]
Sample script for a chat with a patient with a description of the rules of effective conversation [Download]
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