Usefulness of whatsapp for discussing difficult cases in pathology practice: a moroccan experience

Abstract

Objective: The primary aim of the study was to evaluate whether the WhatsApp application can be used for obtaining a quick second opinion on histopathological and cytological diagnosis and also for discussing difficult cases in pathology practice. Material and Method: A WhatsApp group named "FESPATH" was created with total of 17 pathologists (the authors of this manuscript as group administrators and 15 general pathologists from 7 different cities in Morocco, working in 12 different institutions as members). The group was used to discuss difficult routine sign out cases, to obtain a second opinion. Pathology-related academic files, books and links were also shared. At the end of 20 months, members were asked to complete a feedback questionnaire. Results: Over a 20-month period, 86 cases were discussed with 515 posted pictures. 78 cases were related to histopathology, and 8 cases to cytopathology. Twenty-one links regarding educational materials and books were also shared. A total of 14 participants out of 17 were active participants, and the majority of them found the discussions very useful for overcoming challenging cases. Conclusion: Sharing microphotographs of histopathological or cytological cases via WhatsApp is a very easy and fast method to obtain a second opinion in pathology practice and also to discuss difficult cases.

WhatsApp guidelines – what guidelines? A literature review

“…No paper presented obligatory guidelines for WhatsApp use, although 12 articles referred to some form of 'guidance' in using WhatsApp. This included rules, [11][12][13] advice, 14 a directive, 15 a protocol, 16 conditions to be met, 17,18 and reminders on proper use of WhatsApp within a group. 19 Three reported following existing (but unstated) guidelines: a generic statement, 20 a recommendation to follow guidelines of a governing body and local hospital regarding patient information, 21 or guidelines for clinical photography.…”

“…The articles came from 10 countries, six each from the developed 1 , 12 , 15 , 17 , 18 , 21 and developing world, 11 , 13 , 14 , 16 , 19 , 20 were published between 2015 and 2019, reporting services started between 2012 and 2017.…”

“…Confidentiality and privacy were addressed in six guidances through anonymisation or de-identification of patient information, which varied by degree. 11–13 , 15 , 17 , 18 When sharing pathology images it was proposed to gain consent when posting full facial photographs, and not give the exact age of the patient, or the region or side of the body. 11 Other guidance stated: it was ‘forbidden to share patient’s identity’; 13 that no message should contain patient ‘identifiers of any kind’; 12 ‘patient identifiable data were [to be] omitted’ but ‘the patient’s initials and a brief clinical description allowed team members to identify the subject without breaking confidentiality’; 17 , 18 and ‘transferring only unidentifiable information’ was permitted.…”

“…Cell phone stewardship refers to careful and responsible management of the cell phone and its contents. 23 Aspects dealt with were limiting phone access by not sharing a phone 15 and through the use of passwords and pin numbers, 11 , 14 , 16 image and message deletion, 14 , 15 , 17 , 18 , 20 and ensuring secure data transmission. 17 , 18 As WhatsApp has been end-to-end encrypted since April 2016 the requirement of using a secured wireless network 17 , 18 has become redundant.…”

“…Guidance on consent was provided in three articles; one was a clinical trial 17 and two required consent for photography. 11 , 22 Five articles addressed consent which was written and informed in a clinical trial, 17 verbal 20 and obtained ‘where possible’ or ‘implicit’. 16 Some did not see consent as a major obstacle, 16 and sharing images for ‘discussion for educational purposes’ was considered legally and ethically acceptable even without consent.…”