Telemedicine and remote patient communication are fundamental elements of modern medical practice. Studies show that as many as 70% of doctors in Poland allow patients to contact patients after an in-patient visit — mainly via SMS, WhatsApp or private emails. Despite their apparent convenience, these solutions carry a serious risk of data security and legal breaches [9].

In the face of modern challenges — diseases of civilization, an aging society and shortages of medical staff — traditional health care based solely on personal contact is not enough [2]. Therefore, it becomes crucial to find safe and effective methods of remote patient communication that can effectively complement traditional care.

In this article, you will learn about the advantages and limitations of written remote communication between a doctor and a patient (using the example of a medical chat).

Conditions for secure remote communication

In order for remote communication with the patient to be safe and compliant, at least 3 basic conditions must be met:

• Remote contact should only be with the patient, whom the doctor already knows and conducts in an inpatient setting. Such written communication is therefore a complement, not a substitute for personal contact. The guidelines of the Medical Ethics Commission of the Supreme Medical Council (NRL) emphasize that telemedicine services should be provided on the basis of a prior doctor-patient relationship [3].
• Remote contact between the doctor and the patient must be carried out only through the medical tools intended for this purpose. These are, for example, specialized medical chats that give the doctor access to patient records and ensure the safe storage of data in accordance with the GDPR. The obligation to protect patients' data arises from legal provisions, including the draft amendment to Article 9 of the Medical Ethics Commission of the NRL, the Act on Information System in Health Protection of 28 April 2011 (Journal of Laws of 2021, item 666, as amended) and the Regulation of the Minister of Health of 8 May 2018 on types of electronic medical records.
• Remote contact with the patient via medical chat should be fairly remunerated and take place within a clearly defined time frame. The doctor should be able to devote an adequate amount of time to the patient, and his work should be adequately remunerated.

Examples of tools for safe medical communication

Currently, there are many platforms available on the market in Poland and abroad that meet the above requirements and guarantee safe communication with the patient. These include Doctor.One (Poland), Beterdichtibj (Netherlands), Lemonaid (United States), Celo Health (New Zealand) and Doctolib (France). All of these platforms provide a secure exchange of messages about the patient's health status, full access to medical records, and the ability to track treatment progress.

In turn, communication channels that are not adapted to contact with the patient should be avoided. These are among others. WhatsApp, SMS, private email, Telegram, Instagram or Facebook. These popular instant messengers do not provide an adequate level of data security and do not comply with the requirements of the GDPR.

Advantages of using medical chat

The use of medical chat in communication with the patient brings many benefits to both the doctor and the patient:

• Increase patient involvement in the treatment process: Physician-patient communication is a key component of treatment that positively influences its outcomes [5]. Medical chat bridges the gap between appointments — patients can ask additional questions, clarify doubts and better follow recommendations. Doctors, in turn, can monitor the effects of treatment on an ongoing basis and flexibly change recommendations without waiting for the next appointment. This form of contact increases adherence to recommendations (compliance), implementation of the therapeutic plan (adherence) and agreement with the doctor (concordance) [6].
• More efficient use of doctor's time: Not every situation requires a personal visit. The doctor can efficiently perform many tasks through remote written contact — sending and discussing test results, modifying recommendations, saving recommendations, extending prescriptions for existing drugs, and controlling the effects of treatment and patient parameters [7].
• Reduction of unnecessary in-office visits: It is estimated that 40% of in-office visits in Poland are unnecessary [8]. The use of remote patient contact allows the doctor to take care of patients whose problem does not require an inpatient visit, thus freeing up space for others in need.
• Medical records in written form: the chat transcript is part of the medical record and can be used as potential forensic evidence.

Limitations of medical chat

Despite its many advantages, medical chat also has some limitations that must be taken into account:

• Lack of non-verbal communication and the ability to physically examine the patient: remote written contact 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. Remote contact also does not allow to examine the patient at a distance, so it should not be used for diagnosis.
  Also read: Medical chat: practical tips and conversation script
• Necessity of educating doctors and patients: both doctors and patients do not always have 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.

Examples of dangerous online behavior and recommendations

Below are examples of situations in which communication with a patient through popular but non-medical tools may violate the rights of the patient and compromise the security of his data:

• The patient asks to issue a prescription via SMS: the doctor should not issue prescriptions on the basis of SMS messages (based on the graphic “You have a message from the patient: SMS MESSAGE”). The prescription issued in this way does not meet the formal requirements and can be challenged by the National Health Fund. In addition, sending medication data via SMS is incompatible with the GDPR (developed in cooperation with Jędrzej Stępniowski, legal counsel).
  • What can the doctor do in this situation? He can offer the patient a teleconsultation or make an appointment through a teleconsultation platform, where it is possible to issue an e-prescription (developed in cooperation with Olga Doroszewska, an expert in medical communication).
• The patient sends the results of the tests to a private e-mail: the doctor should not take the test results to a private email address (based on the graphic “You have a message from the patient: GMAIL”). This method of data transmission is incompatible with the GDPR, because the private e-mail box does not ensure an adequate level of security of medical data (developed in cooperation with Jędrzej Stępniowski, legal advisor).
  • What can the doctor do in this situation? It can ask the patient to send the test results through a secure medical communication platform that meets the requirements of the GDPR (developed in collaboration with Olga Doroszewska, an expert in medical communication).
• The patient sends a photo of skin lesions via Messenger: pictures from patients are a quick and effective form of transmitting important information about the patient's health status to the doctor in remote contact, which is a complement to in-patient visits (based on the graphic “Photo from the patient on Messenger?”). From a legal point of view, this is health data, i.e. a special type of personal data to which an increased level of protection should be applied (developed in cooperation with Jędrzej Stępniowski, legal adviser).
  • What can the doctor do in this situation? In such a situation, the doctor should inform the patient that he cannot accept the photos sent by Messenger and ask to send them through a secure medical communication platform that meets the requirements of the GDPR (developed in cooperation with Olga Doroszewska, an expert in medical communication).
    Watch: Webinar - Safe remote contact with patients - free training - Doctor.One

Summary

Safe online communication with the patient is a key element of modern healthcare. Physicians, by choosing the right tools and observing safety rules, can effectively support patients while protecting their personal data and rights. Technology should serve to improve the quality of health care, always respecting the ethical and legal principles that govern this care.

Źródła:

1. Na podstawie analizy popularności komunikatorów wśród lekarzy w Polsce.
2. Opieka zdrowotna w Polsce – wyzwania i perspektywy, Ministerstwo Zdrowia, 2023.
3. Uchwała nr 12/18/VII Naczelnej Rady Lekarskiej z dnia 16 listopada 2018 r. w sprawie zasad etyki lekarskiej.
4. Ustawa z dnia 28 kwietnia 2011 r. o systemie informacji w ochronie zdrowia (Dz. U. z 2021 r. poz. 666, z późn. zm.).
5. Komunikacja lekarz-pacjent a efektywność leczenia, https://www.researchgate.net/publication/318676386_Komunikacja_lekarz-pacjent_a_efektywnosc_leczenia
6. Wpływ komunikacji na przestrzeganie zaleceń lekarskich, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6149260/
7. Telemedycyna w praktyce lekarza rodzinnego, https://www.mp.pl/pacjent/telemedycyna/ekspert/291978,telemedycyna-w-praktyce-lekarza-rodzinnego
8. Raport "Niepotrzebne wizyty w POZ", IQVIA, 2019.
9. Raport “Pacjent w telefonie – niewidzialny etat lekarza”, 2024.

Artykuł został przygotowany we współpracy z dr. n. społ. Antoniną Doroszewską, ekspertką komunikacji medycznej, Studium Komunikacji Medycznej, Warszawskiego Uniwersytetu Medycznego i dr n. med. Bartłomiejem Zalewskim, lekarzem specjalistą pediatrii i Liderem Zespołu Pediatrycznego w Doctor.One oraz radcą prawnym Jedrzejem Stępniowskim.