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In a manner of speaking, Filipinos have long embraced the mobile lifestyle.  Most students have cellphones now, whether a college freshman or a gradeschooler, and they usually keep it in their pockets, waiting for call from parents or bus service so they could be picked up.  Most become queasy when they’re already away from home and they find out they’ve left their cellphones behind.  Long gone are the days when friends chat over phone about the day’s happenings; now they’d chat over YM or skype or have a barrage of text exchanges.  Even the neighborhood’s basurero can be seen toying with his cellphone while resting from his work.

And this lifestyle has permeated almost all aspects of the society.  Fitness clubs would request for members’ cellphone numbers so they could send them SMS regarding new promotions/contests.  Some radio shows have adopted SMS for “text”-in contest votes or song requests.  Hell, it has even invaded the banking business, in which one can request a brief bank account statement.

So, it wasn’t long when Filipinos realized that they can use this new technology to further enhance communication with their medical doctors (though delivery of health care via telephone have long been used, since 1876, when Alexander Graham Bell recorded his first telephone call asking help after he spilled sulphuric acid on himself)

In my years of practice, I’ve frequently encountered patients who do consultations over SMS.  These are some examples of such messages:

1)  ”Doc, I have cough.  3 days na.  What do I take?”

2)  ”This is X, friend of Y, he gave me your number.  I have urinalysis test, can you tell me what this means?”

3)  ”Si Lolo ayaw gumising.  Parang maputla.  Ano kaya nangyari?”

The most common message would be Case #1.  The problem I have with it is that people assume that when there’s cough, there’s an automatic corresponding medication to take.  I think if people will take notice, doctors do ask a lot of questions during  consultations.  How long has he had cough?  Was it productive of sputum?  What color was the phlegm?  Did he have fever?  Is there anyone in the house who’s had cough for a long time?  There could be more questions, depending upon the answers derived from earlier questions.  And certainly, some patients do find this quite annoying, not realizing that history-taking is part of the process of diagnosing an illness.  Thus, the problem I find with SMS consultations is that proper history-taking is hindered.

Case #2 is something that I get often too.  A bit harmless but can be a bit frustrating, especially when I realize that the person asking the question has not actually followed up with the doctor who requested for the test.  Progress in management of illnesses have been slow due to patients who have not come back for follow-up or have resorted to doctor-shopping.  On the other hand, this is a practice that is done sometimes by some patients and are welcomed by their doctors, but only if: 1) doctors already know the patient’s medical history well enough to make a sound judgment; and 2) it is done with respect for both the patient’s and doctor’s private lives.

Case #3 is perhaps the worst SMS consult I’ve got.  It actually came from a cousin, whom for reasons that I don’t understand, preferred to send me an SMS  rather than call directly to tell me that our grandfather is unconscious.  I mean, why waste precious minutes typing away an electronic message when he could have had told me the same information in a matter of seconds by simply pushing the call button?  And, not to discount the fact that the situation itself is an immediate emergency that would have warranted an trip to the ER ASAP, no questions asked.  It might have been panic on his part.  However, this is the kind of situations that average people should already know how to manage: seek immediate medical help.  And SMS-ing will not give you that.

So, what did I do to my cousin who texted me that?  I immediately called his number, told him to get Lolo into the car, drive to the nearest hospital and I’ll meet him there.  It’s an advice that could have been delivered several minutes earlier, IF only he had called instead of sending an SMS.

As for the question of whether a doctor should give his cellphone number to his patients or not, I’d say it’s an option for the doctor whether he’d give his cellphone number (and which cellphone number).  But for the sake of better patient management and doctor-patient relationship, it is preferable to give it.  Some studies have shown that patients feel highly satisfied and reassured that they can contact their doctors whenever the need arises.  It has even cut down the number of unnecessary trips to the emergency room (unfortunately, we still don’t have a local study on this yet, as far as I know).

However, with this privilege also comes responsibilities.  Patients do have duties too, as suggested by Evans in his article published in Journal of Medical Ethics, “Do patients have duties?”

Here are some suggestions:

1) As patients do have the right to seek medical care, doctors, too, have the right to healthcare.  And healthcare includes having some sleep whenever time permits them to.  There are doctors who go on 24-hours duties, like resident physicians.  After that 24-hours duty, they don’t go home but usually have to stay in the hospital to give help to those in duty for that day, at least, during office hours (and so the duty isn’t actually just 24 hours but 36 hours).  And so finally, after that 36-hours shift and he finally gets home, the last thing he’ll want to deal with while he’s in the process of catching a long-awaited sleeptime is someone calling in the middle of the night asking him to interpret some lab results.  Though doctors have a duty to take care of their patients, patients should also realize that doctors are human too.  If it is not an emergency, then try to inquire those questions during normal waking times.

2) In conjunction with #1, please learn how to identify common emergency situations.  This is both for the benefit of the patient and the doctor.  There are clinical situations that require doctors to see patients physically to be able to diagnose correctly.  Doctors have been trained to rely on a good history and physical examination to make diagnosis.  So, please don’t expect your doctors to be able to diagnose your illness based on “an abdomen that is aching all over” and unrelieved by intake of “a small, white, round tablet” sent thru SMS.  If there is high-grade fever, difficulty breathing, severe abdominal pain, chest pain, shortness of breath, or unresponsiveness, then definitely it’s an emergency.  Go to the nearest hospital and tell your doctor that you’re there or you could just let the hospital staff to do it for you.

3)  If you really need to speak with your doctor because of pressing matters, then list those questions down so that when you’re able to reach your doctor, you’d remember all those questions.  It is time-saving both for you and your doctor.

4)  Please do not give out your doctor’s cellphone number to someone else, unless you have asked his permission to do so.  There may be some reason why he’d rather have you know his number but not somebody else.  And I think it is also common courtesy to be asking permission before giving out such important information.

5)  Usually, phone consultations are time-constrained.  It would be better if a follow-up appointment to the doctor’s clinic is arranged after a phone consultation has been done, just so that both the patient and the doctor can review their progress over the treatment regimen.

I believe, in the near future, Filipinos would also begin to utilize the email system as a means of communicating with their doctors.  Video conferences discussing progress in treatment wouldn’t be a far-fetched idea too.  But no matter what kind of technology will be used, ethical rules should always be observed.  As doctors are duty-bound to take care of their patients, patients do have the duty to take care of their own health by being well-informed and to be respectful that their doctors do have rights too.

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