We need digital discipline in the NHS

In this opinion piece, Vedamurthy Adhiyaman, a consultant geriatrician in North Wales, makes the case for the cultivation of basic ‘digital discipline’ in order to ensure ethical, effective communication with clinical colleagues.

Digital media is ubiquitous; it's the first thing we engage with in the morning and the last before sleep. On average, a person dedicates 3-4 hours daily to digital media¹. WhatsApp has emerged as the primary communication tool in hospitals, yet its misuse is now overshadowing its benefits.

WhatsApp messaging has replaced the traditional bleep system due to its ability to facilitate instant multimedia communication, proving highly effective for one-on-one interactions and group messaging. During the Covid-19 pandemic, WhatsApp groups became essential within the NHS for enhancing patient care and workforce management. However, the use of WhatsApp for sharing ECGs, X-rays, scans, etc., has recently faced criticism for compromising confidentiality². With the surge in hospital group chats, individuals often find themselves in numerous groups. If one includes the private groups, one could spend hours actively engaging on the app every day.

Within groups, there are active and passive users, and the messages are largely influenced by an active user rather than by what is pertinent. The lack of moderation in group chats has turned them into an outlet for expressing frustration, anger, and even assigning blame. Without clear ownership or governance, it becomes difficult to ascertain who is responsible for addressing the posted queries. Moreover, not everyone is constantly connected to their phones to receive these messages.

When the hospital gets extremely busy, the immediate reaction from the people with managerial roles is to post a message in a large group asking clinicians to discharge patients. Many such messages invariably make a comment on the number of older people in emergency departments and urge geriatricians to do something about them. These indiscriminate messages can be sent at any hour, blurring the lines between professional and personal time. Additionally, group memberships are not regularly updated, leading to former employees retaining access, which poses a risk to confidentiality.

While it is necessary to have mobile phones on hand at work for checking guidelines and urgent contacts, the frequent checking of phones for personal messages during ward rounds and educational meetings has become both common and accepted. Such behaviour is not only distracting but also unprofessional.

Email is another form of communication that is often misused. Mass emails that demand clinicians to discharge older patients without proper assessment are not only disrespectful but also undermine the clinicians' role. These emails are overwhelming and typically provoke angry responses, leading to a point where they are ignored. The issue is compounded when individuals use 'reply all' to respond to an email. Coupled with a minimum of a dozen daily emails from various organizations, one might receive approximately 300-400 emails per week. Sorting through such a high volume of emails is a time-consuming and daunting task, particularly when returning from leave.

Technology does nonetheless have the ability to enhance our working lives. Smartphones are highly resourceful and should replace the outdated bleep system. Clinicians would not need to use WhatsApp if a secure and effective multimedia communication alternative were available, which the current bleep system lacks. But the key is that the selected communication medium must be used properly and with moderation. Patient care issues should be addressed by speaking with the relevant clinician or in a smaller group, rather than broadcasting messages in a large group. Common sense should prevail when sending or responding to emails.

Everyone should cultivate basic digital discipline and etiquette to enhance communication, patient care, and maintain confidentiality. Taking breaks from continuous digital interaction can be rejuvenating. Overindulgence and improper use of digital media can lead to digital fatigue and degeneration, undermining its effectiveness as a communication tool.

References

1. online-nation-2023-report.pdf (ofcom.org.uk). Accessed 8th April 2024
2. Armstrong S. What will happen if doctors can’t use WhatsApp? BMJ 2024; 384 :q52 https://doi.org/10.1136/bmj.q52