Abusive

Over the weekend, some of my colleagues and I were in discussion over text consultations by patients to their doctors and the ethical dimensions surrounding text consultations.

With over 93 million active mobile phones AND 130 billion text messages being exchanged each day in the Philippines (yes, ONE HUNDRED THIRTY BILLION) you can undoubtedly state that text messaging has been widely used, and may I say, disproportionately abused by the Filipino patient.

Text messages fly back and forth between the patient who 99.9% of the time triggers the initiation of text messages, and the physician.

During the discussion, we asked how many of us gave out their cellphone numbers to their patients. Three out of five had their mobile numbers on their calling cards, prescription pads and 100% available to their patients. I give my mobile number to about 30% of my pool of patients. Only one of us REFUSED to give her mobile number to any of her patients.

Some of us buy a second phone (which I think is impractical) or even go to the extent of having a dual SIM phone so that one can be a private number while the other number is an office phone number on the same cellphone. Whatever it is, the bottom line is that once you give out your mobile number - your privacy has been invaded.

Many (if not most of us) do not give pre-arranged instructions which should be something like:

1. They're not allowed to call! I am not your text mate, I don't plan to be and I don't like it when people who are NOT in my contact list call me IF and WHEN they want. I do not save the numbers of my patients in my contact list. And I cannot stand the temerity of some patients who ask me to SAVE their numbers! Duh!!! Most of all, I may not be in town and if I am out of the country, I end up paying for the roaming charges because someone just wanted to find out what they can give their son because he apparently has fever of 37.8C!
RULE NO. 1: TEXT BEFORE YOU CALL. It's only but fair and etiquette dictates it, to see if the other party can pick up your call.

2. They should include their names or identify themselves when they send text messages (because I don't save your names). You should also not expect an answer in the next 5 minutes or when you want a reply. (I may be at meetings or in a plane somewhere or in a movie house [YES we have a life outside of the clinic my dear patients], or doing something in private [ahem, I hope you people get what we mean] or seeing other patients or driving.) In short, we are NOT at your beck and call.
RULE NO. 2: IDENTIFY YOURSELF. Don't waste my money having to text back - "who is this please?" or have to guess "this is the mother of Joaquin..." Joaquin who?!?!! It's not like your son is the only one that has the name Joaquin in the Philippines. You can ask the National Bureau of Investigation and you will get gazillion hits with that name alone!

3. They should be more specific with the concerns that they text us with (if the patient has fever - describe the pattern of the fever and not just text "may lagnat si Junior, what to do?". The reason for this is because we spend replying back to them as well (usually I don't reply back if they don't observe the rules I inform them when I give out my mobile number from the get-go). But because the text message service is probably UNLI, these patients think that it's alright for them to waste other peoples time by engaging in texting back and forth. Of course, if they pay more for the text message, I guess this should put them in the proper perspective of having to think what to text before they send a text message.
RULE NO. 3: Complete the description of the concern. Please avoid having to make me guess what the hell the concern is about by just texting me that there's fever or there's tummy ache or other one liners. Try to be as comprehensive as possible. Be considerate with other people's time.

4. In case of emergencies, DO NOT CALL ME! I am not an emergency room. Just bring the patient to the ER. Period. The ER will call me.
RULE NO. 4: I am not an emergency room.

5. No MMS messaging please! There are those that actually send pictures of a lesion on the skin of their child and expect me to make a diagnosis and a prescription!!!
RULE NO. 5: First of all, I do not prescribe through text. It is unethical to do text consultations and against the LAW to prescribe prescription drugs by text messaging. Besides, sending a picture of patients is like pathetically altogether wrong. You don't see the whole picture and cannot make a clear diagnosis without a good history and thorough physical examination.

6. I can't stand it when patients text me in the middle of my clinic asking if "they can call me" because their kids are sick. They know my clinic hours. They know my schedule. They can call the clinic. But NO!!!! They don't want to do that!!! They don't want to call the clinic because the secretaries are busy assisting me and other patients. They don't want to queue. You can even see how inconsiderate the others are because they will call the clinic, ask the secretary they want to talk to me because his kid got bitten by a mosquito a few seconds ago and they're afraid of dengue!?!?!!?! I want to slap someone today. But puhleezzzz, gimme a break! My secretaries are trained to tell patients that "I am seeing a patient currently and that we will get back to them after office hours".
RULE NO. 6: There is a secretary in the office. Do not text me if you want to find out if we have clinic or not. Text the office or call the clinic.

While these are but a few among my many concerns, these are basic rules that I make patients follow if they want my number. It is ironic that many of them seem to have early onset Alzheimer and forget that these rules.

So there's got to be a way where physicians and patients know that there is and there needs to be a yardstick distance between them. After all, the relationship between doctors and patients is strictly a professional one. We are not removing the human factor of having to relate with patients - showing empathy, explaining the burden of the disease, explaining in layman's terms the treatment options, and most of all staying within the ethical boundaries in the practice of health care.

Somewhere along the way, technology has provided a vast avenue of easier communication between people anytime, anywhere. And like anything that's highly accessible, comes abuse. Without anyone or any other way to regulate this abusive practice, it's bound to get virally blown out of proportion. While text messaging has its positive attributes, it should be relegated to before and after service only. Before service which means that patients inquire only for consultation hours and minor concerns on whether the doctor is around, and after service means that the patients may have concerns on medications or instructions after the consultation or discharge and text messaging is only for clarification purposes.

There is a need to get the whole equation back to professionalism, ethical relationship, and most of all the etiquette of mobile phone usage has got to be taught to the general public ONCE AND FOR ALL.