Recently there has been a steady increase in the use of Instant Messaging (IM) as a means of providing health and healthcare services. This growth has been particularly rapid during the ongoing COVID-19 pandemic. Many reports indicate informal services using IM, in particular WhatsApp, have arisen spontaneously, in the absence of any formal guidelines and little consideration of consent. This study documents the consent practices of healthcare professionals using IM for clinical activities in District Hospitals in KwaZulu-Natal, South Africa and compares these practices with the literature.
As part of a larger audit of telemedicine activity in KwaZulu-Natal a survey questioned clinicians’ use of IM, including consent practices and awareness of regulatory guidelines. Concomitantly multiple electronic databases were searched for papers on WhatsApp use in clinical service. Inclusion criteria were: papers written in English, reported on WhatsApp in clinical use or potential clinical use, and addressed consent.
The survey confirmed anecdotal reports of widespread informal use of WhatsApp in District Hospitals. Most clinicians were unaware of regulatory guidelines, and few obtained consent for taking photographs or sharing of images and information with colleagues for consultation. The literature review found that consent was mentioned in only 28 papers. Of these 11 reported that written consent was obtained, of which 5 were for taking photographs and 4 for sharing information with colleagues.
The survey showed that more than half of the respondents who used IM did not consider this to be telemedicine, with the corresponding ethical requirements governed by national guidelines, thereby risking legal exposure. However, South Africa’s regulatory guidelines do not align with common clinical practice. The literature shows that the majority of doctors shared patient information by IM without obtaining any form of consent.
Practical guidelines are urgently required in South Africa and worldwide that balance practical conduct of medical care with sound contemporary ethical principles. Prudent guidance will ensure clinicians do not inadvertently breach patient privacy and confidentiality laws whilst permitting continued health-related use of instant messaging.