In a bustling paediatric clinic in Coimbatore, Tamil Nadu, India, the day begins not only with appointments but also with a steady stream of WhatsApp messages from anxious parents. The screen flickers as a mother text for advice, the urgency in her tone unmistakable: her 4-year-old son has a high-grade fever and refuses to eat, she is scared. Amita (name changed), the Physician Assistant (PA), grabs the phone and responds quickly. This scenario is not new to her. In fact, it plays out multiple times in the day and she is specially trained to handle it. WhatsApp for their clinic has become a lifeline, connecting the doctor to over 12000 patients yearly, with Amita as the channel. In this growing tier-2 city, with a population of about 3.5 million out of which 76% (2.6 million) is urban and a literacy rate of 83.98 compared to national average of 72.98, healthcare demand is on the rise. The paediatrician, thus, juggles back-to-back appointments, rounds, and emergencies. This commitment to care also extends beyond the clinic via WhatsApp, helping the patients avoid unnecessary clinic visits while preventing overcrowded waiting rooms that delay care.
WhatsApp, a messaging app with over 2 billion worldwide users, is increasingly used for medical consultations, offering quick and convenient communication. However, the sheer volume of messages due to easy access can overwhelm the doctors, creating a digital bottleneck that impacts care.
What began as a tool to address patient concerns more effectively has become a full-time task, requiring clinic staff to manage messages. Patients often share concerns via voice notes and videos, as the clinic primarily serves urban smartphone users. The risk of missing an emergency message places a huge responsibility on the doctor, making a trained assistant essential. Differentiating routine messages from an emergency- like a fever in a 4-year-old vs a newborn or a routine allergic skin rash from an unknown insect bite- demands good knowledge, thorough training and specialized skills. Thus, the doctor chose to train a Physician Assistant who had 5 years of formal university training followed by 3 years of OPD/IPD experience to ensure accuracy in triaging.
A Novel Approach to WhatsApp Consultations
When the parents text the clinic’s official WhatsApp business number, Amita acts as the first responder, managing the constant flow of messages and triaging each case. She assesses the urgency of the complaints based on reported symptoms (fever, rash, etc.) and categorizes them as regular or urgent.
For non-urgent cases, Amita provides the initial advice, and they are scheduled for a follow-up appointment with the doctor. For urgent cases, such as high-grade fever or injuries, she arranges a video or tele-consultation with the doctor at the earliest, while in case of emergencies, the patient is advised for a mandatory clinic visit at the earliest or directed to the nearest hospital facility. For urgent or emergency cases, proper record keeping with all details is done. On a typical day, they receive anywhere between 100-150 messages and a review of all important messages and reports sent on WhatsApp is done by the doctor with the PA at the end of the day which may take well over an hour to complete.
This unique triage helps prioritize the cases and deliver timely intervention to the ones that require it the most, without burdening the doctor or the physical resources at the clinic. The WhatsApp-assisted care process followed at the clinic is depicted in Figure. 1.
The Flipside
The app offers parents convenience and peace of mind, allowing them to message the doctor from home for timely advice on minor ailments, building their trust in the doctor. However, for the paediatrician, the practice has its challenges. More accessibility means more messages, with some parents reaching out even for minor worries, adding to the workload. Beyond this, the app’s design raises ethical, data security, and privacy concerns. Unlike formal healthcare apps, it also lacks legal cover, leaving doctors and patients vulnerable.
“I want to be there for my patients, but I also know I don’t have the legal cover on WhatsApp. I want my advice to be properly documented and my patients to feel secure about their data and privacy. Right now, it’s a balancing act”, says the doctor.
The Way forward
To address these challenges, the doctor is exploring apps that offer encrypted messaging, video/audio consultation and proper documentation. A refined process could ensure both accessibility and security for patients and the doctor.
One solution is a tiered subscription-based WhatsApp care process, where patients choose services based on their need- text consultations, audio/ video calls, or emergency after-hours care with recorded audio consent for legal purposes. This shift is more than business-it’s about sustaining quality care while respecting both doctors’ and patients’ time. Through this, the doctor aims to balance personal connection with fairness and integrity.
The doctor’s case highlights how messaging platforms like WhatsApp are revolutionizing healthcare by enabling swift and accessible communication and screening, particularly in resource-limited settings. While these practices significantly enhance care delivery, they also pose challenges, including resource constraints, minimal record-keeping, privacy concerns, and inadequate legal protections.
However, these practices can be adapted to facilitate the timely delivery of quality care by emphasizing the development of innovative, secure platforms that ensure accessibility while safeguarding data privacy, obtaining patient consent, and maintaining proper documentation. Such solutions strike a balance between the benefits of digital communication and the ethical and legal responsibilities critical to safe and effective healthcare.
Authors: Kamal Kant Sharma, an implementation researcher and health program management expert, currently affiliated with the Max Institute of Healthcare Management at the Indian School of Business, India, with more than a decade of experience in research and leading health programs.
Dr Saranya Manickaraj, a Paediatrician and Neonatologist at Sri Ramakrishna Hospital, practicing at Saranya Clinic, Coimbatore, India, brings 17 years of paediatrics experience. She is a member of the National Neonatal Resuscitation Program (NRP) Committee and holds an MD in paediatrics and a fellowship in Neonatal-Perinatal Medicine.
Navsangeet Saini, a doctorate in mass communication, brings extensive experience in academics, communication research, and writing. As a writer at the Max Institute of Healthcare Management, Indian School of Business, India, she leverages her expertise to address critical issues in healthcare through research and writing.
Competing interest: None
Handling Editor: Neha Faruqui