A few weeks ago, one of our patients at Sherpaa created a case on a Friday afternoon. Sherpaa works like email— asynchronous messaging between our doctors and patients:

  • People create cases by choosing “I’m sick, “I’m hurt,” “I need a refill,” etc..
  • Once they choose the type of case, there’s a big free text box asking them for as detailed a story as possible.
  • Our doctors read the story and fire back anywhere from 10 to 30 questions to explore more targeted details.
  • Patients answer the questions.
  • If the diagnosis is clear from the history, we’ll then treat you with medication or whatever you need and communicate with you throughout the issue to make sure your health is on track.
  • If the diagnosis is unclear but we need to confirm a diagnosis, we’ll send you to the lab or radiologist to get confirmation and then we’ll treat you.
  • We diagnose and manage 70% of cases (~500 conditions) but refer 30% of patients to be seen in person.

This patient’s situation wasn’t an acute or urgent one and it involved something she’d been dealing with for a while. She described her situation in two paragraphs and submitted the case. A few minutes later our doctors sent her 24 questions diving deeper into her current health situation. Normally patients respond to the questions within a few minutes or hours. But then we didn’t hear from her over the weekend. But Monday afternoon we received responses to the questions and it was prefaced with:

“I’m sorry for the delay. I spent all weekend thinking about my responses to these questions.”

That hit me hard. This is such a fundamental shift in how doctors and patients communicate. It allows both our doctors and patients to take time to think about communication. The traditional doctor office visit is short with rapid fire questions and little time for both doctors and patients to think. Not only that, traditional visits are in person typically with a doctor with whom you don’t feel 100% comfortable. You have to look them in the eyes and tell them something embarrassing in a very short amount of time. Over the last 4 years, I can without a doubt say that our doctors get a far more detailed, more thoughtful, and more honest story from our patients. We’ve created questionnaires for our top 250 main complaints. These question sets have a few goals:

  • Use standardized language that’s best understood by patients
  • No jargon. If jargon is needed, link out to the best online resource that best explains the concept (this might be a video)
  • Ask questions that definitively rule out serious or emergent issues
  • Ask questions that rule in the most likely diagnoses

And then, my friend Jenna Wortham at the Times published today entitled We’re More Honest With Our Phones Than With Our Doctors about apps that track menstruation where she states:

“The researchers found the data collected via Clue to be more detailed — and more accurate. “The data is as close to real time as we can get,” McDonald said. They hope their young participants will be more comfortable telling a faceless app about personal health matters — a slump of depression, gross blood clots, irritated bowels — than telling a doctor. And it’s not just teenagers; most of us are willing to be much more honest with our phones than with professionals, or even with our spouses and partners. We look up weird symptoms and humiliating questions on Google with the same ease that we search for the name of a vaguely familiar character actor. For many of us, our smartphones have become extensions of our brains — we outsource essential cognitive functions, like memory, to them, which means they soak up much more information than we realize. When we hand over this information willingly, the effect is even greater.”

Welcome to our world Jenna. This is exactly what we’ve been doing for the last 4 years, except not just for periods. We’ve been doing it for the entire breadth of primary care. Sherpaa is the only place in healthcare where the entire conversation is text from beginning to end. Oral conversations in healthcare have their place, but 70% of healthcare should not be oral. It should be thoughtful messages with plenty of time to contemplate and write your story.