You messaged your doctor on WhatsApp. Should that be billed?

For pediatricians like Laura Krynski, who lives in Buenos Aires, the volume of WhatsApp messages sent by patients’ parents has become overwhelming. She told Rest of World some of the parents get so anxious about their sick child, that they start to text her compulsively — sometimes in the middle of the night, sometimes verging on harassment. “The quality of my personal life has been affected because I’m expected to be online all the time. It’s a massive workload that cannot be monetized,” she said.

For private health professionals across Latin America, WhatsApp is both a blessing and a curse. Medical practitioners in Argentina, Guatemala, and Mexico told Rest of World the app has become an essential tool for doctor-patient communication. Its use has blurred the boundaries as to what is appropriate to send and when. It also muddles the distinction between a billable medical consult and casual advice, often putting doctors in a compromising situation. “You make yourself available through WhatsApp just for emergencies or follow-ups, but once you get lab results, photos or personal medical records on your phone, you become medically responsible to handle all that information. Few of my patients understand that [medical attention] has to be paid for,” Krynski said.

Private medical practitioners in Latin America are often perceived as customer-facing professionals, since public health systems are overwhelmed and private practice is pricey. María Mercedes Ancheta, a gynecologist specializing in high-risk pregnancies in Quetzaltenango, a city in Guatemala, told Rest of World that generally, her patients are understanding, but a few “pay for one consultation and consider you their property: available at all times.”

The same is true in Mexico, where a private medical consultation costs 750 to 1,500 pesos ($40 to $80), while the country’s daily minimum wage is 207.44 pesos ($11). “If I didn’t offer my WhatsApp number for follow-ups with patients, they’d go to another doctor,” María Fernanda Fernández, an OB-GYN and sexologist who works across Mexico, told Rest of World.

All the practitioners Rest of World spoke to said that WhatsApp is the best platform to stay in touch with patients, despite the many issues that come with its use and their attempts to replace it with other, more professional platforms. Over 90% of people in Guatemala, Argentina, and Mexico have a WhatsApp account. It is free and easy to use, doctors said, allowing even less tech-savvy patients to send photos, videos, audio files, and PDFs. 

Despite her frustration with her patients’ need for constant interaction, Krynski, like many doctors, shares her WhatsApp number on the first appointment. For practitioners with high-risk patients, like those who are pregnant or very young, WhatsApp can be a genuine lifesaver. Manuel Soriano, a pediatrician from Mexico City, told Rest of World the app is key to determining if one of his regular patients needs to be taken to the hospital urgently or if they just need some at-home care and rest. Ancheta spoke of times when instant messaging had helped avert possibly fatal complications. Beyond the medical uses of instant communication, “a text is a way for [patients] to simply feel supported,” she said. 

There is no legal impediment or official medical protocol regulating what sort of information or sensitive material patients and doctors can share over WhatsApp. Soriano told Rest of World the absence of legal guidance on data privacy puts the safety of both parties at risk. Personal medical records, including lab tests, medical history, and prescriptions, are shared freely between patients and medical practitioners through the platform. This makes doctors particularly worried about the need to protect themselves from accusations of malpractice, misuse of personal medical information, or even from what could be considered harassment. Fernández told Rest of World she sometimes gets “disturbing” photos of her patients’ sexual organs that she never agreed to receive.

Mostly, though, what concerns doctors is the gradual encroachment of patients on their time. Questions that would have previously been restricted to formal appointments can now be easily sent at the click of a button. Patients expect quick replies from the medical practitioner at the other end — be it for instant medical advice, as a customer service expectation, or as a matter of courtesy.

“Sometimes, patients don’t understand I’m not an acquaintance or a friend, but a healthcare professional, and they address me quite informally and repeatedly,” Eugenia Gaytán Olaguivel, a surgical odontologist from Mexico City, told Rest of World.  

Patients, on the other hand, don’t expect to be billed for these interactions. According to doctors who spoke to Rest of World, this was despite the fact that their messages tended to come very late at night, on weekends, or repeatedly throughout the day. 

Fernández, the OB-GYN, realized that after her patients sent her their lab results over WhatsApp, many would then choose not to pay for an in-person appointment. “You end up losing that income,” she said. 

Doctors told Rest of World they still hadn’t found a health-tech platform — created specifically with online medical appointments in mind, one that allows doctors to bill their patients — as easy to use and as widely accepted as WhatsApp.

Gaytán Olaguivel and Paulina Benítez, a nutritionist from Mexico City, use a health-tech service called Doctoralia to automatically book medical appointments and send reminders. But Benítez told Rest of World the platform’s video and audio call functions are often spotty, and she almost always ends up switching to WhatsApp. “It’s much easier for my patients, especially older ones who don’t know how to use Doctoralia,” she said. Some doctors said they use other platforms including Zoom, Google Meet, and email, but ultimately always end up going back to WhatsApp. 

Without any readily available alternatives, doctors have opted to deal with the issue of WhatsApp overload through boundary setting. Soriano, Krynski, and Benítez said they have had to “educate” their patients to stop sending them so many messages. 

Krynski recently went one step further. To keep in touch with her patients without compromising her personal time, she bought a new phone with a new SIM card, with which she created a new WhatsApp for Business account. She turned off read receipts and wrote a disclaimer in her WhatsApp status message: “I’m not online 24/7. Leave your question in writing — no audio messages or photos. Thank you.”