Inevitable, important and immediate

At the elite level of sport, the majority of SEM clinicians will use some form of instant messaging (IM platform) for three main purposes:

1. To discuss player findings with other staff members.

2. To plan treatment sessions.

3. To interact with athletes to reassure/advise them on their status and recovery.

Table 1 outlines examples of these, and other methods by which the modern clinician can use IM platforms to enhance their communication strategies.

The future is already here

The initial shift toward virtual communications began with the introduction of ‘telemedicine’, which provided clinicians in all forms of medicine with innovative platforms to communicate with their patients and colleagues.2 The emergence of the smartphone then allowed even easier access to IM platforms. WhatsApp is currently the world’s popular IM platform with 2 billion users3 and its widespread adoption has led to its integration in many medical settings, including as a simple and efficient communication tool in stroke medicine4 and emergency surgery.5

Benefits of WhatsApp

A key factor in the use of WhatsApp by clinicians is the widespread of WhatsApp by Millenials, with 84% of adults aged 24–35 years old in the UK using WhatsApp.6 Given that a large proportion of athletes are in this generational group, WhatsApp is clearly a platform that athletes are already comfortable in using. For many clinicians, responses to emails are too slow to share effective and up-to-date information between the medical team, coaches and athletes. WhatsApp provides the ability to communicate with many individuals at once through group chats, allows the sharing of images/videos/PDFs within the message itself and enables the sender to know when messages have been read by the recipient.

Crossing all the t’s: have we?

IM platforms are yet to be perfectly regulated for the medical setting. While WhatsApp provides end-to-end encryption (meaning that messages can only be seen by each of the users), encryption is not effective for group messages.7 The widespread sharing of sensitive patient information by doctors through IM platforms without patient consent is of concern,8 and medicolegal implications in the use of WhatsApp for clinical interactions have not been fully explored. Bullying seen in other domains of sport may also transcend into interactions through WhatsApp, as outlined by the example in table 1. Practical guidance covering clinical interactions via WhatsApp in SEM is yet to be clearly defined, and the role that WhatsApp group moderators can play in communication via WhatsApp also requires more exploration. Notably, the nuances associated with the use of WhatsApp and other IM platforms for medical communication in elite sport are not fully understood. The nature of the relationships that SEM clinicians have with uninjured athletes in their squads is clearly different to that of a general clinician working with members of the public. As such, the nature of SEM clinician–athlete communication via WhatsApp is also likely to be different, and consideration how to achieve professionalism in this setting is required.

An evolving reality

The current covid-19 pandemic has put an increased spotlight on embracing telehealth approaches across all forms of healthcare, including SEM. WhatsApp may be the platform of choice for many SEM clinicians now, but history has indicated that newer and better platforms are always around the corner. Rather than become wedded to the use of just one specific IM platforms, SEM clinicians should consider how they can best use any new communication platforms which emerges. Adhering to existing best-practice communication recommendations from the respective Professional, Statutory and Regulatory Bodies, in conjunction with staying abreast of technological advances in the field of communication, will help to future-proof clinicians with these technologies.