Every sound of an incoming message can mean another request for help. Every phone call raises the question, "Is there anything else I can do?" For many doctors in Poland, such situations are an everyday occurrence, not an exception. The "Patient on the Phone" report sheds light on this disturbing reality. In this article, you will learn what difficulties doctors face on a daily basis after closing the office door, what solutions are already available and what hope the future holds.

Main findings of the study "Patient on the phone "¹

• 76% of doctors in Poland have contact with patients outside the office.
• More than 50% of doctors use a private phone to respond to patients' text messages.
• Forty-three percent of doctors receive messages from patients via private email, while 33 percent use channels such as WhatsApp and Messenger.
• Only 14% of doctors regularly use a professional medical communicator.
• 80% of specialists are not paid for time spent consulting outside the office.

What are the implications of the current situation?

• Blurring the line between doctors' private and professional lives.
• Reduced time for rest and recuperation, increasing the risk of burnout^.2
• Difficulties in maintaining continuity of treatment and guilt in doctors due to incomplete patient records.
• The problematic status of medical data transmitted through private communication channels that do not make it into official records^.1

Threats to privacy and security of medical data

The virtual undeclared employment of physicians poses a legal problem. It concerns the sensitivity of patient data. Privacy in medicine is crucial. Illness brings not only physical suffering, but also the risk of stigmatization, discrimination or ^{exploitation3}. Information about the need for medical care can attract those willing to take advantage of such a situation. Popular communication tools like WhatsApp, Messenger and email do not provide adequate privacy protection. Data can be used to create advertising profiles of ^patients1. Moreover, their use can lead to violations of ^medical confidentiality1.

Is widespread telemedicine exacerbating the problem? 

Available telemedicine tools are characterized by prioritizing the needs of patients, not doctors. As a result, the available platforms may contribute to the exacerbation of the phenomenon of the "invisible full-time" after hours. Current research shows that as the number of messages requesting medical advice from a patient increases, the volume and intensity of work as perceived by doctors of various specialties also increases, rather than improving the practice of the ^profession4. Telemedicine in its current form is proving to be inefficient and increasing the physician's workload.

Telemedicine 2.0 is coming

Although the problem is complex, it is not insoluble. Paradoxically, the answer to these challenges is a new era of telemedicine solutions. It is possible to transform and modernize existing digital tools to create a system that improves the work of doctors. An example is therapy companion apps, which are gaining popularity in the market and are already showing promising statistics to prove their effectiveness.

Statin treatment is an established therapy for people at high risk of cardiovascular disease. However, one of the main challenges remains the low adherence to treatment associated with the occurrence of symptoms resembling ^intolerance .5 In response to these complaints, the "Statinterface" app allows patients to monitor their symptoms on a daily basis while on therapy.⁵ The app also provides patients with the ability to monitor their symptoms on a daily basis. At the same time, with the doctor's well-being in mind , the app provides him with control over structured patient data and notifications. In contrast to traditional telemedicine, research indicates that healthcare professionals see the app's potential to improve communication with patients and treat diseases more effectively based on reported symptoms.

How do we at Doctor.One design for the challenges of physicians?

The doctor is a pilot, not a passenger

In the app, it is the doctor who has the decision-making power regarding which patients require more comprehensive care through the app and which form of contact (chat or phone call) is most appropriate for the problem. This gives the specialist full control over the number of patients in the app.

Doctor doesn't have to be on call all the time

The Doctor.one application features asynchronous communication. The patient writes a message and the doctor responds only during his designated time slot. His phone number is unavailable to the patient, so he can't call at any time or book an appointment. In addition, the doctor sets a time frame for rounds. According to statistics so far, it does not take more than 30 minutes a day. This makes it possible to create a relationship with the patient based on trust, empathy and professionalism.

Physician receives fair compensation for care

The subscription model allows the doctor to be fairly compensated for his or her time with the patient. By making the doctor's compensation independent of the consultations performed (as in traditional telemedicine), the doctor is rewarded for the value of patient care(in the spirit of value-driven medicine, which we wrote about in this article).

Doctor and patient safety first

Medical communicators are designed with the security and privacy of both doctor and patient in mind. The software is used to provide medical services, so there is no possibility or concern that sensitive content shared by the patient will be used for marketing purposes. In addition, the issuance of prescriptions and referrals is regulated and the doctor has the ability to do so as part of a consultation through the app.

Involving the doctor in designing the solution

All the features that exist in the Doctor.One application are preceded by needs and usability studies. The co-creation of the solution with doctors allows it to be tailored to doctors' current challenges and goals. In this way, another solution is not created that adds work and burdens the doctor for the benefit of the patient.

1. COBIK NIL & Doctor.one. (2024). The patient on the phone - the invisible doctor's office. In Report of the National Survey of Physicians About Contact with Patients Outside the Office.
2. Mandal, S., Wiesenfeld, B.M., Mann, D.M. et al. Quantifying the impact of telemedicine and patient medical advice request mes sages on physicians' work-outside-work. npj Digit. Med. 7, 35 (2024).
3. Véliz C. (2020). Not the doctor's business: Privacy, personal responsibility and data rights in medical settings. Bioethics, 34(7), 712-718.
4. Mandal, S., Wiesenfeld, B.M., Mann, D.M. et al. Quantifying the impact of telemedicine and patient medical advice request messages on physicians' work-outside-work. npj Digit. Med. 7, 35 (2024).
5. Cao, W., Li, L., Mathur, P., Thompson, J., & Milks, M. W. (2023). A mobile health application for patients eligible for statin therapy: app development and qualitative feedback on design and usability. BMC medical informatics and decision making, 23(1), 128.