Health care is obsessed with new technology. Every week, a new article comes out promising disruption of medical care as we know it through personalized genetic therapy, app extensions that transform smartphones into ultrasounds or autonomous surgical robots. Yet, one of the best examples of health care technologies is also one of its oldest — instant messaging.
Though the original messaging platform AOL Instant Messenger was sadly discontinued at the end of 2017, it birthed many other programs that are now used in a variety of sectors, particularly within the Veterans Health Administration. Providers at any VA can message each other to and from any facility computer in real-time.
As a new primary care physician in my intern year of internal medicine, I had found this means of communication incredibly helpful and easy. If a heart failure patient was having trouble managing his salt intake, I could message the dietician to see him right after my clinic visit. If he started experiencing lightheadedness, I could ask my LPN to bring over the glucometer while I asked him more about his symptoms. If he had questions about transitional housing, I could quickly type to the social worker three floors above me if he could be seen today and, if so, at what time. Anyone can message me back, like my clerk to let me know that a patient is stuck in traffic or the pharmacist with questions about a prescription. We can indicate if we’ve stepped away from our monitors, and savvier users can even post away messages (“The devil works hard, but an RN works harder”).
Physicians are already accustomed to messaging each other, usually through the immutable pager system. But pagers are exclusive to the same hospital system, whereas I’ve successfully instant messaged providers in other states about my recently-relocated veteran’s imaging reports or clinician notes. Furthermore, pagers are not designed for conversation but quick alerts: “call me back” or “come to room X.” This is appropriate for certain situations, but definitely not every. And that system is imbalanced since not every care provider carries a beeper. In a world where so much of health care now revolves around data on a computer, it is unreasonable that in this age of technology explosion, a simple tool like messaging is not more widespread.
Perhaps this is because messaging is so basic. And this is a deep problem of invention versus innovation competing for our attention.
The truth is, health care does not suffer from lack of resources. We are just not optimizing what we already have. There exists a glut of literature on the social determinants of health, but one of the most striking numbers is that behavioral factors and social circumstance impact the overall population’s health at 40 percent and 15 percent respectively compared to only 10 percent by medical care. This doesn’t mean that medical care is important. It is, especially for certain patients. But if we really want to take care the maximal number of people, and do it well, providers from all disciplines have to start talking to each other. And the means of communication must be accessible, effective and universal.
I once had a new patient who was skeptical of the medical system. He had only come to the VA because his paranoid schizophrenic son had scheduled a day of psychiatry appointments that morning and he figured, what the hell, he could see a PCP at least once. We ended up getting an EKG that revealed a third-degree heart block, putting him at very high risk for immediate and fatal arrhythmia. Despite this, he resisted going to the ER. Who would sit with his son in the waiting rooms? Who would drive him the two hours it took back home, and when?
After an honest discussion, he agreed to go with our nurse who navigated their way down to the ER. I spoke with the emergency physician and cardiology consult team about his case to facilitate a smooth transition of care. Meanwhile, one of the hospital volunteers would keep his son company between appointments and then escort him to the ER. Our tireless social worker would meet them there to either arrange a ride home for the son or, if he desired, an overnight stay in a family room to be near his father. The son ultimately opted to go home by wheelchair van, and the father was discharged a few days later with a brand-new ICD and peace of mind.
This coordinated transition was made possible through messaging.
The alternative would have been to try to force the patient to get a pacemaker. Although medically indicated, that route would have willfully ignored his other needs and is completely avoidable. More hospital systems need to understand that it is crucial for today’s physicians to communicate well with every type of provider and invest in instant messaging to expand the role of traditional medical care to include health and well-being care.
We do not need a world-changing invention to change the world. We cannot be blinded by the glitter of new invention if what is required is innovating of an existing ability. There are already excellent people working in the health care system who are individually smart and talented and motivated. But we could do even more, even better if we finally started talking to each other.
Eunice Zhang is an internal medicine physician.
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