Sadie Mullin: Instant messaging in the workplace is no substitute for a professional conversation

Instant messaging poses a significant threat to effective communication in the workplace. NHS England’s stance on use of instant messaging to discuss patients is clear. Due to the inherent risk to confidential data, it is currently banned. However, recent research shows that it is widely used amongst professionals.

Most medical and surgical firms now communicate through a communal instant messaging group. Throughout the day, questions are asked predominantly by junior members and answered by seniors. Places to meet, handover, and ward rounds are also discussed. How do we train ourselves to consistently separate the wheat from the chaff in terms of information received? For example, take the escalation of an unwell postoperative patient.  

The nurse on the ward pages the F1 shortly after the ward round when she takes the observations of the patient and finds him to be febrile, tachycardia, and asking for more pain relief. Other members of the team are already in theatre and have started the first case. After review the F1 messages her team explaining that the patient seems more unwell. Does the registrar want her to start antibiotics? Should she order some x-rays?

There are several key ways in which this method of communication renders patients directly at risk. Most importantly, this form of messaging creates a delay. After sending a message, the understandable perception of the doctor is that they have shared responsibility for an unwell patient and escalated appropriately. In fact, information regarding the actual patient status remains in the digital ether. Nobody senior is actually aware of any deterioration. Nobody is enroute to review, no investigations have been ordered. All sense that the problem has now been shared is mythical.

Detailed professional conversations are paramount to patient safety. They always have been. They are how we have been trained to communicate with each other. They represent core values of our profession and yet they are becoming obsolete. An instant message is no substitute, it does not possess the communicative vigor to keep patients safe. Furthermore, all opportunity for tone (often relaying concern), body language, and most importantly a platform for prudent questions to be asked is lost. We underestimate how the dynamism in our exchange has the potential to directly enhance or hinder patient care.

Thirdly, instant messaging regarding an unwell patient is inappropriate. In reality, we open our devices at an opportune moment and are faced with a selection of messages, some from family and friends, some from the workplace, most are largely unimportant. We are desensitized by the volume and speed at which we are contactable. But a patient’s clinical state is of vital importance. We cannot expect ourselves to be able to sift for clinical gold amongst the barrage of communication from our smartphones.

Psychiatrists have demonstrated that we aren’t even aware of the vast extent of time we spend using our smartphones. Cognitive bias results in an average 40% underestimate of self-reported vs actual usage time.

It would be wrong to imply advancement in IT hasn’t enhanced patient safety—it has. But we need to be mindful of what patients stand to lose if the way we communicate with each other continues to shift so rapidly.

Sadie Mullin is an ST1 in Obstetrics and Gynaecology in Bristol. 

Competing interests: None declared.

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  • David Levine

    Congratulations Sadie on your coherent and achievable suggestion for maintaining safe practice. There’s a great amount of rubbish written on this subject but if clinicians were only to act on one new recommendation I suggest it should be what’s in this article.