“I do not give consultation on WhatsApp, Twitter, Instagram, Facebook or Skype.” The phrase appears every so often in the profiles of some doctors from Guayaquil and opens the debate on where is the limit between what can be diagnosed by social networks.
A group of professionals consulted by EXPRESO recognizes that their accounts have received the strangest queries, with photographs included, of certain parts of the body leaving place or even a child’s dirty diaper.
In the digital age, the issue has mobilized those involved. In the United States, a guide was created on what the doctor should and should not do and, in Argentina, the Pediatric Society also issued warnings, knowing that parents are the ones who most use these tools to consult about what happens to their children.
In Ecuador, WhatsApp or Facebook is used, for example, to schedule medical appointments or remember them, to transmit laboratory tests or to communicate results. And to diagnose and prescribe? Each doctor has its limits. A group of professionals tell their anecdotes.
“They send pictures of the dirty diaper”
A patient recently sent me a photograph of her baby’s dirty diaper and wrote to me: Saskia look at how she made the poop. I thought it could be parasites or diarrhea due to infection, but it was rotavirus diarrhea. In the photos, many times the case looks worse than it really is. In addition, sometimes people do not solve their doubts in the query and then send, at any time, the questions on WhatsApp. Once they wrote to me on a Sunday around 11pm to ask me if a 10 month old baby could be given Greek yogurt, which is not an emergency. They also write me at night to ask what vitamins they can give their children.
“We must value the patient”
Among the consultations that have made me as an oculoplastic ophthalmologist, there are some related to problems in the lacrimal area, palpebral and even orbital tumors, for which I have invited the patient to the consultation to assess it completely, since the medical act covers the diagnosis, knowing the personal history, at what stage is the disease, treatment, professional secrecy and several points that ethically for a message or photo by WhatsApp cannot be done in a comprehensive manner. For an emergency, such as an accident, it is recommended, because one can guide people on what to do, what not to do and where to go.
“It happens to us all”
There are unusual consultations, such as when the condom remains inside during a sexual relationship and they write to me on WhatsApp. I ask them to call me to give instructions or, if necessary, I recommend them to come. Sometimes, the spouses send me messages and I reply that I need to speak directly with the patient. Of course, there are cases in which I ask for the photo, for example, if a pregnant woman does not know how to describe her bleeding. I also had a patient who came months ago for a health problem, we solved it and I did not know about her until recently that she wrote me to prescribe for the infection in the urinary tract. She had not even been tested. I told her to come to the office, but she answered that she was not in the country. I suggested that she should find a doctor where she was.
“I call them and I explain”
They send me pictures of the presence of blood in the toilet. In my opinion, the patient must be served and with a call to explain the diagnosis so that they make the decision to make an appointment and thus obtain a complete assessment. Sometimes the photo can diagnose a disease that is observed, but there are other hidden, such as rectal cancer, which are discovered with complementary exams. I think a photo does help a lot. Once they sent me one of a cancer from the outside of the anus and the patient then began his treatment. In my specialty, many patients send me photographs and I warn them that they should take an appointment because they have to make a clinical history followed by the introduction of endoscopic devices.
“The expectation changes”
One of the rarest queries I received through social networks was that of a mom who sent me the photo of the loss of her son’s tooth due to a fall. When she arrived at the office, she wanted me to reimplant the tooth, but it was not possible. In the message she sent me, she did not tell me that the child had fallen three days before, so when it was done, nothing could be done because the hole was closed. There are people who have high expectations making queries for WhatsApp, but from the photo to reality there is a difference. Now it is very common for people to want medication through social networks. They also write to corroborate a diagnosis that another professional gave him and to know the prices.
Doctor and lawyer
“There is no law that regulates”
We must differentiate when we have a consultation for a middle process emerging, for example, if the person has a fever, colic or if he is infarct. We could, more or less as 911 does, give you directions. You can prescribe certain medications, something transient, until you go to a normal consultation. The issue of accessibility must also be a bit unclear. We are going to suppose that it is raining or that the doctor of your confidence is out of the country, there you could attend to it by message. Technology has advanced and laws are being adapted, but there is no law that sanctions for prescribing or not by social networks. If it is about caring for a child, it can be prescribed as long as we know that the mother will understand what we want to convey. (I)