WhatsApp, Doc? Instant messaging in times of crisis

Mr Matt Dunstan is an ST6 Trainee in General Surgery in South West London. In this blog series, he describes how, with the help of instant messaging, team dynamics have changed during the coronavirus pandemic. 

It's 7.55pm. My phone displays the time in bright, white text above a stream of green message notifications. Handover is in five minutes. I better make my way downstairs.

Before standing up, curiosity gets the better of me and I open up my messages. A few from my partner, she's on nights, so I probably won't hear much from her for the next 12 hours. A couple from assorted friends who I really should have replied to sooner. And then there is our on-call team message group.

The first thing that happened after the new ‘COVID-19 rotas’ were announced was that our team message group was established. It started simply as a logistical tool, for coordinating staffing and confirming meeting times. Of course, we have a similar, secure system for patients' sensitive information. However, this group is unlike any team that I have worked with before. The structure is the same: we have consultants, registrars, senior house officers, FY1s, and now even some 'interim FY1s', who would be in Bali, South America or Africa were it not for COVID-19. However, my team isn't just made up of surgeons anymore. We have all manner of surgeons and every flavour of medic.

‘Who is covering acute medicine tonight?’, one message might enquire. I would dutifully reply, ‘call me on ext 3579.’ An FY1 from another ward hands over a simple job with unprecedented ease, and with no concern over the perceived hierarchy between us. ‘Is anyone free to give me a cardio opinion?’, I might message. A telephone call follows. Senior advice is obtained within minutes. My bleep lies quietly in my pocket.

Through a simple direct messaging app, something else has grown. An ever-evolving, dynamic and cooperative team. A team with a unity that has broken down the traditional barriers that have separated us. Barriers of specialty and hierarchy, of fear or preconception.

I continue to swipe through my phone: the messages are punctuated by names that I would never have expected to see there, such as the medical consultant that I barely knew two weeks ago, and with whom I now have a flowing conversation. I don’t speak to some of my usual bosses with this ease. ‘Are you ok, do you want to get a coffee tomorrow?’ Last night’s message. Last night was a bad night.

Communication technologies have rightly been lauded during the COVID-19 pandemic. Video messaging apps have allowed patients to spend their last moments with their relatives. They have re-taught doctors how to communicate with one another. To solve clinical problems rapidly and to support one another at a time when burnout is a huge risk. They have reminded us that our team is more than just a specialty-specific column on a rota. Rank and specialty are no longer defining characteristics. We have so much to gain by challenging traditional barriers and just talking to each other, by any means.

There's a message on my surgical registrar group about 'the rota', and plans for when the pandemic is over, when things begin to return to normal. It occurs to me that my team message thread will quieten down soon. The cynical part of me fears that my newly familiar team will soon drift away again into obscurity, behind bleeps, referral etiquette and tacit protocol.

It's 7.59pm now. I'll message the group to let them know I'm on my way.

'We have so much to gain by challenging traditional barriers and just talking to each other, by any means.'

This blog is from our series COVID-19: views from the NHS frontline. If you would like to write a blog for us, please contact content@rcseng.ac.uk.