Health care based solely on personal contact with the patient is not sufficient today, especially in the face of challenges such as progressive civilization diseases, an aging society and shortages of medical personnel1.
Both doctors and patients know this today, which is why it is a common phenomenon in the Polish health care system to make contact available to patients after an inpatient visit. Research shows that among Polish doctors, the most popular form of contact with patients outside the office is SMS, Whatsapp or private e-mail2.
In this article, we will look at the advantages and limitations of remote written contact (e.g. in the form of a medical chat) between doctor and patient taking into account three basic conditions.
Prerequisite 1: Remote contact should only be with the patient, whom the doctor already knows and conducts in an inpatient setting.
Articles 8, 9, 10, 11, 40 for the provision of telemedicine services of the Medical Ethics Commission of the Supreme Medical Council (NRL)3. Such written communication is therefore a complement, not a substitute for personal contact.
Prerequisite 2: Remote contact between the doctor and the patient should take place only in the tools intended for this. Such tools are medical chats, through which the doctor has access to medical records and stores the patient's medical data in accordance with the GDPR. Draft amendment of Article 9 of the Medical Ethics Commission of the National Medical Council (NRL) and the Act of 28 April 2011 on the information system in health care, as well as the Regulation of the Minister of Health of 8 May 2018 on types of electronic medical records.
Condition 3: Remote contact with the patient in the medical chat should be fairly remunerated and take place within a clearly defined time frame.
Examples of chat rooms in Poland and in the world that meet the above conditions: Doctor.One (Poland), BeterdichTibj (Netherlands), Lemonaid (United States), Celo Health (New Zealand), Doctolib (France).
Examples of channels that should not be used for written remote contact: Whatsapp, SMS, private email, Telegram, Instagram, Facebook.
Advantages of using medical chat with a patient - from a doctor's perspective
Increase patient compliance, adherence and concordance.
Communication between doctor and patient is a key aspect in the treatment process and positively influences the therapeutic process4. Given the limited time of the inpatient visit and the staggered follow-up appointments, it is sometimes difficult for doctors to answer all the questions and clarify the doubts that often arise during therapy. On the other hand, the patient, left alone after the visit, more than once looks for information in unverified sources and begins to trust the attending physician less and less, which can even result in the interruption of the treatment process5. Medical chat can bridge this gap between appointments and gives patients the opportunity to ask additional questions, dispel doubts, and better adhere to written and easily accessible recommendations. In turn, it allows doctors to control the effects of treatment and flexibly modify orders without having to wait for the next appointment. This form of contact can therefore contribute to better adherence to recommendations (compliance), adherence to the therapeutic plan (adherence) and agreement with the doctor (concordance)6.
More efficient use of doctor's time
In the process of treating a patient, not every contact requires a personal visit. While the in-patient visit is most often necessary to carry out the first visit with the patient, perform diagnostic activities and build the doctor-patient relationship, it is no longer necessary in the case of certain therapeutic, preventive or judicial activities. Submission and discussion of test results, modification of procedures, recording of recommendations and recommendations, renewal of prescriptions for previously prescribed drugs, control of treatment effects and patient parameters - all these activities can be carried out using remote written contact with the patient7. This use of medical chat allows the doctor to use his time with the patient more effectively. While an in-patient visit takes an average of 15 minutes, a quick chat message with a patient, e.g. to confirm the dosage of a new drug, takes no more than 5 minutes.
Reduction in the number of in-office visits
It is estimated that 40% of in-office visits in Poland are unnecessary8, which not only results in a huge burden on the health care system, but also means that patients who actually need to receive the necessary medical help on time do not receive it. Therefore, the use of remote and asynchronous contact with the patient allows the doctor to take care of patients whose problem does not require an inpatient visit, thus freeing up space for others in need.
Written documentation
The recording of the chat that takes place between the doctor and the patient in a designated place (e.g. medical messenger) is part of the documentation and can be used as potential forensic evidence.
Limitations of medical chat - from a doctor's perspective
Lack of non-verbal communication
Remote written contact with the patient limits the ability of the doctor to analyze the patient's non-verbal communication, which can be useful when performing diagnostic activities. This form also makes it difficult for the doctor to show care and empathy for the patient.
Inability to examine the patient
Remote contact and current technological capabilities do not allow the doctor to examine the patient at a distance, so it should not be used for diagnosis.
Lack of experience
Both doctors and patients have no experience in remote communication. Physicians should develop skills in maintaining relationships with patients through written chat, as well as communication skills using this form of contact, taking into account its context and limitations.
The article was prepared in cooperation with Dr. Antonina Doroszewska, expert in medical communication, Medical Communication Study, Medical University of Warsaw and Dr. Bartłomiej Zalewski, doctor specialist in pediatrics and Leader of the Pediatric Team at Doctor.One
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