Health care based solely on personal contact with patients is not sufficient today, especially in the face of challenges such as advancing lifestyle diseases, an aging population and shortages of medical ^staff1.

Both doctors and patients already know this, which is why it is common in the Polish health care system to make contact available to patients after an inpatient visit. Studies show that among Polish doctors, the most popular form of contact with a patient outside the office is SMS, Whatsapp or private ^email2.

In this article, we will look at the advantages and limitations of remote written contact (e.g., in the form of medical chat) between a doctor and a patient considering three basic conditions.

Prerequisite 1: Remote contact should only be with a patient the doctor already knows and is managing stationary.

Articles 8, 9, 10, 11, 40 for the provision of telemedicine services of the Medical Ethics Committee of the Supreme Medical Council (NRL⁾.³ Such written communication is therefore a supplement to, not a replacement for, personal contact.

Condition 2: Remote contact between doctor and patient should only take place in tools designed for this purpose. Such tools are medical chat rooms, through which the doctor can view medical records and store the patient's medical data in accordance with RODO. The draft amendment of Article 9 of the Medical Ethics Committee of the Supreme Medical Council (NRL) and the Law of April 28, 2011 on the information system in health care, as well as the Ordinance of the Minister of Health of May 8, 2018 on types of electronic medical records.

Prerequisite 3: Remote contact with a patient in a medical chat room should be fairly compensated and within a clearly defined time frame.

Examples of chat rooms in Poland and around 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 affects the therapeutic ^process4. Given the limited time of an inpatient visit and the staggered nature of subsequent visits, it is sometimes difficult for doctors to answer all questions and clarify doubts that often arise during therapy. In turn, the patient, left alone after the visit, often seeks information from unverified sources and begins to trust the treating physician less and less, which can even result in the discontinuation of the treatment ^process5. Medical chat can bridge this gap between visits and gives patients the opportunity to ask additional questions, address concerns, and better adhere to written and easily accessible recommendations. For physicians, in turn, it allows them to monitor the effects of treatment and flexibly modify orders without having to wait until the next visit. This form of contact can thus contribute to better adherence to recommendations (compliance), adherence to the therapeutic plan (adherence) and agreement with the doctor (concordance⁾⁶.

More efficient use of a doctor's time

In the process of treating a patient, not every contact requires an in-person visit. While an in-person visit is most often necessary to conduct an initial visit with a patient, perform diagnostic activities and build a doctor-patient relationship, it is no longer necessary for certain therapeutic, preventive, or adjudicatory activities. Sending and discussing test results, modifying treatment, recording recommendations and recommendations, renewing prescriptions for previously prescribed medications, monitoring treatment effects and patient parameters - all these activities can be carried out by means of remote written contact with the ^patient7. This use of medical chat allows the doctor to use his time with the patient more efficiently. While an inpatient visit takes an average of 15 minutes, a quick exchange of chat messages with a patient, for example, to confirm the dosage of a new medication, takes no more than 5 minutes.

Reduce the number of inpatient visits

It is estimated that in Poland as many as 40% of inpatient visits 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 assistance from a doctor in a timely manner 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

A record of a chat that takes place between a doctor and a patient in a designated place (such as a medical communicator) is part of the documentation and can serve as potential court evidence.

Limitations of medical chat - from a doctor's perspective

Lack of non-verbal communication

Remote written contact with the patient limits the doctor's ability to analyze the patient's nonverbal communication, which can be useful when performing diagnostic activities. This form also makes it difficult for the doctor to show care and empathy to the patient.

Inability to examine the patient

Remote contact and current technological capabilities do not allow a doctor to examine a patient remotely, so it should not be used for diagnosis.

Lack of experience

Both doctors and patients lack experience in remote communication. It is necessary to develop doctors' skills to maintain relationships with patients through written chat, as well as communication skills using this form of contact, taking into account its context and limitations.

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This article was prepared in collaboration with Dr. n. social. Antonina Doroszewska, medical communication expert, Medical Communication Studies, Medical University of Warsaw, and Bartlomiej Zalewski, MD, pediatric specialist and Pediatric Team Leader at Doctor.One