Zapping Doctors’ Orders to Patients in Brazil

WhatsApp messaging is big in Brazil’s healthcare, but for some doctors it’s a mixed blessing.

The WhatsApp messaging mobile app is widely used as an mHealth tool in healthcare in Brazil.
The WhatsApp messaging mobile app is widely used in Brazilian healthcare. Photo from Jan Persiel, Flickr

By the time patients make it from their homes or workplaces to the office of Dr. Roger Rohloff, Clinical Director of the Perinatal Intensive Care Unit in Rio de Janeiro, Brazil, he’s often already looked at images of their symptoms and answered some of their pressing questions. That’s because Rohloff, like most physicians in Brazil, is in direct contact with patients via texts, photos and all because of the phone-based messaging app, WhatsApp. “For us doctors, it’s almost impossible to work without it now,” says Rohloff.

WhatsApp has become a big part of patient-clinician healthcare communications in Brazil. Most healthcare professionals in the country now rely on the app for some aspect of their work, with nearly nine out of ten doctors using WhatsApp to communicate with patients. The obvious advantages include patients’ improved access to their care providers, and an easier way for clinicians to monitor patients and update care instructions.

But there are downsides, too, and not just about privacy. For one thing, clinicians who may already be struggling to keep up with workloads must now contend with an unending stream of messages at all hours from patients who expect a quick reply. What’s more, not all of the interaction feels necessary or helpful. “Patients send me images of vomit and feces,” says Rohloff. “I even get messages from patients asking for my office hours. They skip my secretary and come straight to me.”

WhatsApp, widely referred to informally as “Zap” in Brazil, relies on Wi-Fi connections in order to exchange texts, group messages, phone calls, and audio and video messaging among users all over the globe. In Brazil, WhatsApp is nearly ubiquitous on mobile phones, and has largely replaced SMS texting. It was inevitable that healthcare would get on the Zap-mania, especially since WhatsApp automatically encrypts messages, making them relatively secure compared to other forms of communication.

The messages are often helpful to delivering better care to patients faster and more conveniently, says Rohloff. “Zapping” patients allows him to give advice, allay concerns and even prescribe medicines, often making a costly and time-consuming visit to the office unnecessary. The pictures patients send can play an important role in cutting down on superfluous visits, too. “In dermatology, patients can just send pictures of lesions to their doctors,” he says.

But the extra accessibility can be overwhelming to clinicians, especially during what should be off-hours. Rohloff points out he can’t let the patient assume he hasn’t read the message yet, because WhatsApp notifies the sender that the recipient has seen it. “It kind of forces me to give an immediate response as soon as I read it,” he says.

Privacy and service reliability may also be concerns. Brazilian courts have ruled that Facebook, which owns the WhatsApp service, must in some cases give Brazilian law enforcement and judicial offices access to WhatsApp messages, including the ability to monitor accounts. Facebook refused a court order to do so in three separate occasions, with the most recent case being in July 2016, bolstering patients’ and physicians faith in the privacy of their communications. But the Brazilian government responded by closing WhatsApp down in the country for up to 12 hours, electronically stranding patients dependent on the service for medical guidance.

Rohloff says that Facebook’s strong stand justifies trusting in WhatsApp’s privacy. And he downplays the risks of tying patient communications to a service that can be summarily shut down, noting that most patients in critical need of contact are able to revert to more conventional forms of communication with their clinicians.

In any case, he adds, the convenience and increased access provided by WhatsApp tend to outweigh the potential risks and drawbacks. “It’s not the foundation of all our interactions,” he says. “But it’s become a major asset to our work.”


— Tarsilla S. Moura

Tarsilla S. Moura is the managing editor at GHCi.


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