As I entered the patient’s examination cubicle, I noticed him hurriedly taking a picture of his x-ray in his smartphone. The x-ray was hung upside down and I instinctively corrected it and asked him to take a picture. The gentleman coyly took a snap and said, “My sister’s son is a medical student and I wanted to show my x-ray to him.”
Of late, every medical record is pictured by patients on their smartphones since it serves as a repository and a ready reckoner. The moment I ask a patient about his past history, he would whip out his smartphone, proudly open his gallery and scroll the thousands of images up and down a few times and show some of his previous medical consultations. Apart from being stored, the pictures are also sent through WhatsApp to family members and friends. Among the many recent technological advances in the last decade, WhatsApp would stand tall as a creator of disruptive innovation. It has suffused every part of our lives. I notice that it has brought significant changes in the way healthcare is practised and delivered.
Since time immemorial, it has been common for patients to miss their old prescriptions and previous investigations when they come for review. They would let out a sheepish smile, scold their partners or feign ignorance about any such prescriptions. Some patients would try to recollect the medications based on size and shape (“one big yellow-coloured tablet and another small round white tablet, doctor”). With the advent of WhatsApp, we can now retrieve the reports easily, either from the patient’s own phone gallery or someone back in their home would click a picture and send it then and there.
For surgical patients, the assessment of a surgical wound needs a trained eye and consummate judgment. Previously, patients would panic if there is a swelling or slight discharge from the wound and reach the clinic even at odd hours. This was a strain on the healthcare machinery as well as an undue stress for the family members. Now, through WhatsApp, on doubtful instances, patients send pictures of the wound from multiple vantage points and sometimes a video also, which helps in easy decision making. In a huge country like ours, this has been a boon to enable healthcare reach even the most remote villages.
During the COVID pandemic, WhatsApp revolutionised the delivery of healthcare when the lockdown and travel restrictions were in place. Patients from faraway cities and villages consulted doctors through this app. The assessment of urgency of a clinical situation could be made through WhatsApp and immediate treatment initiated. Patients who needed long-term prescriptions received their new ones without moving out of their safe havens. Follow-up radiographs to assess disease healing and regular blood investigations for long-standing kidney, cardiac and liver diseases were performed at nearby labs and the reports were vetted by their regular specialists elsewhere through WhatsApp. This enabled continuity of healthcare without allowing the disease or COVID to rob someone’s health.
The communication between members of the healthcare team has also tremendously improved after WhatsApp’s advent. The decision-making head of the team cannot be omnipresent, and radiographs and scan images, blood investigation reports, patient’s wound status and changes in vital parameters can be sent across members of the team for immediate evaluation and decision. This increases the efficiency levels of the junior members and helps them allocate their time for other productive work instead of waiting to discuss the situation in person with the senior doctors. For the senior consultants too, the rapid and effective communication allows them to triage the situation and plan management. The collective wisdom of the team members is also tapped since these situations are discussed in a WhatsApp group which ensures the best possible treatment for a patient. Previously, a multi-disciplinary team physical meeting happened once in a month and now through WhatsApp, this happens effectively anytime, anywhere at the click of a button.
Often colleagues of the same specialty do share the images of a complex medical situation to plan a surgical treatment. It could be a doctor from a small village discussing the situation with a specialist in a metro. Through WhatsApp, the entire history, clinical pictures and radiographs can be shared and discussed, through which a safe treatment plan can be charted out for the patient. Patients’ need to travel far distances to seek specialist medical opinion, thus comes down. It is also a common situation where non-medical friends, relatives and medical colleagues of other specialties share their images comfortably through WhatsApp seeking our opinion to ensure that the treatment that they have been advised is proceeding along the expected lines.
Just like any other technical innovation, free use of WhatsApp in medical practice has its pitfalls. Patient’s anonymity is lost in mindless transfer of images across groups. This leads to infringement on patient’s privacy about their health issues. We saw celebrities’ pictures with their ventilators during the pandemic, and I am not sure whether they were aware of that. Second, doctor’s prescriptions, their opinions and radiographs and other reports are shared through WhatsApp for opinions, judgments and ridicule. Since medical science is not exact and no doctor is perfect, this further throws a spanner in the already jammed doctor-patient relationship. Third, despite rapid strides in medical innovations, the practice of medical science still remains an art with intricate human relationship and emotional attachments. Too much reliance on pictures and messages alone can’t replace the direct doctor-patient meeting and personalised care. Often reports do not completely reflect the real physical condition of the patient.
Despite these minor niggles, WhatsApp has completely transformed the way we deliver and practice healthcare in the last few years. I hope this improves further by leaps and bounds in the years to come, leading to effective, ethical and empathetic care to the people.
