
Brazilian doctors use WhatsApp to talk to patients - herbertlui
http://www.cityam.com/230372/digital-health-wearables-and-apps-9-in-10-brazilian-doctors-use-whatsapp-to-talk-to-patients
======
diego_moita
Everybody in most of 3rd world uses WhatsApp for everything.

The Brazilian Conselho Federal de Medicina (main medical association)
published a memo telling doctors not to use it, but very few will pay
attention.

As always happens in Brazil only a tragedy can make people notice a problem. A
couple lawsuits, some national scandal and people will learn.

Besides, there is also a cultural element here: privacy is a lot more valued
in anglo-saxon cultures than in Latino cultures. Brazilians, Italians and
others are a lot less concerned about things such as personal space, body
contact, exhibiting in a small bikini, going almost naked in a Carnaval
parade, etc.

Edit: Just for HN to have an idea of how big WhatsApp is: since May, the
number of cell phone lines in Brazil is falling. More than 10 million lines
are canceled. Young people are giving up on voice services and using
exclusively WhatsApp for communications.

Source:
[https://translate.google.com/translate?sl=auto&tl=en&js=y&pr...](https://translate.google.com/translate?sl=auto&tl=en&js=y&prev=_t&hl=en&ie=UTF-8&u=http%3A%2F%2Fg1.globo.com%2Ftecnologia%2Fnoticia%2F2015%2F12%2Fefeito-
whatsapp-e-crise-matam-10-milhoes-de-linhas-de-celular-no-brasil.html&edit-
text=&act=url)

~~~
alister
> _Besides, there is also a cultural element here: privacy is a lot more
> valued in anglo-saxon cultures than in Latino cultures. Brazilians, Italians
> and others are a lot less concerned about things such as personal space ..._

Speaking specifically about Brazilians, privacy works differently but so does
"trust". Brazilians prefer to use intermediaries to establish trust much more
so than North Americans:

\- You cannot rent an apartment in Brazil without going through a broker
(unless you know the owner personally). Brazilians will pay a middleman for
some reason. In Canada and the USA, it's the opposite -- almost nobody uses a
broker; the renter and the owner deal with each other.

\- Professional jobs like software development go through recruitment firms
almost exclusively. Whereas a big company would hire directly in the USA, in
Brazil they'll use one of the Brazilian recruiting firms and pay a large fee.
And professionals (such as programmers) will browse the recruiting firm's site
and won't think to apply directly to the company.

\- Brazilians are unlikely to invite a stranger they met (over the Internet,
by phone, or even in person) into their home. Even if the person is a
professional business contact. In Canada/USA, people are much more open to
inviting a business contact into their home. But if the Brazilian has an
introduction to the person by a mutual friend, then the person is no longer a
stranger; he is immediately welcome.

Both privacy and trust work differently in Brazil.

~~~
threatofrain
I wanted to address one of your subpoints, which is that although some
landlords in the US deal with renters directly, many turn to a 3rd-party
management company.

------
sho
Hospital staff in Thailand use LINE to do _everything_ from organising shift
rosters to trading images and instructions for patients. I have personally
seen a (nurse) friend of mine receiving images of wounds from on-duty staff
and giving advice for treatment over the app.

In the absence of some kind of really amazing and free dedicated app, it
actually seems very efficient! I have zero faith in any of those mandated
health information privacy schemes anyway.

~~~
officialchicken
That's too bad you have little faith. But that's because in Thailand there
isn't any mandated privacy, or the laws are toothless. Here in the US, that
nurse could be fined $25,000 every time she hits the 'send' button.

It's a regulatory and educational problem, not a technical one. While it could
be improved, and it's far from perfect, there's no reason what so ever to
believe it's un-fixable.

~~~
brianwawok
I don't think I would want my medical images sent over WhatsAPP....

~~~
prophet_
I can tell you for sure there are millions of people who don't care at all
about having their pictures taken and sent over the net so long as tgey get an
affordable treatment.

~~~
blub
Being desperate can do that. The point however is to offer people affordable
treatments while keeping their dignity and privacy.

------
MichaelGG
WhatsApp is infuriating. I've managed to get the people I chat with to move to
Signal or Telegram (seems a bit more friendly). But there's tons of
resistance. My 9-yr-old doesn't seem to care about the privacy implications of
sending all your writing (and photos) to Facebook, forever. My 7-yr-old does
care, and expressed surprise that it was even legal to "take their secrets"
and "I'd call the police on Facebook." (Her words.)

But I suppose if other parents don't join in (shit most of them use WhatsApp
themselves), what hope do their kids have? And I don't want to get my daughter
ostracized so being heavy handed seems like a long-term losing strategy.

Doesn't help that this is in a 3rd world Central American country and that
vile, anti-net-neutrality zero-rating is in effect for FB stuff. You can
basically pick up any phone, and WhatsApp will work, even if nothing else[1]
does. Apart from the cost of the phone, there's no cost, at all, as far as I
can see.

1: Including emergency, as this country hasn't really gotten to that point
yet.

~~~
JumpCrisscross
I was under the impression that WhatsApp is a relatively secure messaging
platform [1].

I travel, from time to time, to countries such as the UAE, Singapore and
France. I once attempted to get people to use Signal. No luck. HN seemed to
have arrived at a consensus that Telegram is a crock of shit. So I shifted -
in part due to local adoption - to WhatsApp. When their in-app calling was
blocked in each of the above countries, I gained a little faith in their
security model.

[1]
[https://whispersystems.org/blog/whatsapp/](https://whispersystems.org/blog/whatsapp/)

~~~
gareim
I think this might be relevant. Especially the last paragraph.

[http://www.blog.twosense-labs.com/whatsapp-renegs-on-
their-p...](http://www.blog.twosense-labs.com/whatsapp-renegs-on-their-
promise-of-true-message-encryption/)

~~~
JumpCrisscross
> _In interviews with journalists WhatsApp stated that they would use Public
> Key Encryption, where only the sender and recipient can unencrypted content.
> Indeed they did, but they used the same key for every user._

Wow.

------
antirez
Common in Italy too. I find it very useful because you can send doctors exams,
images, and so forth without interrupting like with a call. But is a lot more
real time and personal than emails.

~~~
MichaelGG
Don't you have any issues with sending your detailed medical information to
Facebook?

Signal, or even Telegram (despite it's stupid crypto, the E2E stuff _should_
work if verified right, and it's a marginally better client _at the moment_ )
should suffice without sacrificing privacy.

~~~
antirez
I totally understand the privacy implications, but I'm a person that tends to
extern all its personal facts, so I'm kinda "public" by default, so no worry
about sending what I talk about with even with strangers.

------
fiatjaf
Everybody uses WhatsApp for everything in Brazil. It's the crazy world. It's
madness. It makes me mad every time I see it.

~~~
profeta
ironically, they have laws that demand free SMS on most plans. i think only a
few categories of pre-paid plans do not. Though that is changing. Couple years
ago there were laws that set maximum prices on internet and sms for pre-paid
plans (R$0.5 a day!), but the telcos already lobbied the downfall of those for
this year.

brazil has a huge mentality of "belonging". Supermaket chains that market to
upper-middle class (think whole foods) charge 4-10x more for the same product
(R$20 instead of R$2.50 for bottled water, same brand). and they are usually
just a block from a regular market. yet, you see lines just because people
want to belong by purchasing there.

WhatsApp was huge for people that needed to talk to folks overseas in brazil,
and close to half the upper class and a large portion of the middle class in
brazil sends their kids to study abroad. So flaunting WhatsApp instead of SMS
is also a way to show off.

~~~
mascarenhas
I don't know where the parent lives in Brazil, but the supermarket chain
comment definitely has not been my experience in upper-middle class Rio de
Janeiro neighborhoods.

People use Whatsapp instead of SMS because it simply is a better user
experience, specially for sending media and group chat, not for showing off,
or keeping in touch with relatives abroad. Phone companies began offering
"free whatsapp" even in pre-paid plans because it because it became very
popular, as a way to attract costumers, not the other way around.

~~~
profeta
you are probably a late adopter. 2010 it was used exclusively for overseas
sms. Since nobody had it installed.

Then, after it was bought by facebook, they started to PAY telcos around the
world to increase penetration and block any competitor.

...telcos offering something for free when they have a closed monopoly :) that
was funny.

------
markolschesky
For an American, it's easy to blame this on HIPAA compliance, but IMHO it has
just as much to do with the speed/method in which medical malpractice suits
are managed in Brazil. NPR had an article in which it took 17 years for a
family to finally collect payment for medical malpractice. I also read a legal
brief on the topic which indicated how this is slowly changing in Brazil.

On the other hand, in the US, many physicians are afraid to push the limit
from the norm because they are afraid of being sued. That's not an unwarranted
fear.

Some links on medical malpractice in Brazil:

[http://www.npr.org/sections/parallels/2014/11/05/359830235/b...](http://www.npr.org/sections/parallels/2014/11/05/359830235/brazil-
the-land-of-many-lawyers-and-very-slow-justice)

[http://scholarship.kentlaw.iit.edu/cgi/viewcontent.cgi?artic...](http://scholarship.kentlaw.iit.edu/cgi/viewcontent.cgi?article=3823&context=cklawreview)

------
dpflan
Marketplace Tech had a segment on this concept yesterday. The issues of
ensuring privacy, HIPPA compliance, and record keeping definitely need to be
considered (US perspective). Hooking up dumping such communications to EMRs in
securely acceptable fashion would be a nice middleman service.

[http://www.marketplace.org/2015/12/07/tech/why-texting-
dilem...](http://www.marketplace.org/2015/12/07/tech/why-texting-dilemma-
health-industry)

~~~
herbertlui
Ahh really cool, thanks for sharing! I can see both recorded text and OTR
messaging be useful (across different types of situations)

------
fiatjaf
Does WhatsApp still advertises itself by saying it "costs nothing for the
first year, but after the second you pay $1.99"? has anyone actually paid that
fee?

------
maw
It's become common in Mexico too. I don't know exactly when I first started
noticing it, but certainly I've seen it lots in the past year. Most recently
an ophthalmologist asking a specialist colleague for a quick second opinion
with respect to a condition I have in one of my eyes.

------
dharma1
My health insurance provider has an app I can use to schedule a Skype call
with a GP whenever I need to. Haven't needed to use it yet but makes sense.
They even give out free macro lenses for mobile phones

~~~
ceejayoz
That'd be lovely. My insurer (in upstate NY, US) won't pay for phone
consultations, period.

------
devgutt
"A new global study of how doctors use wearable technology"

where's the global study?

------
pbreit
It's astonishing to me that regular ole texting still has not reached business
considering messaging/texting is otherwise the most popular form of online
communication.

Show HN: we are aiming to make SMS texting more prevalent in business with
Textline.com.

------
bsbechtel
FWIW, we use it to communicate with our vet down here too.

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napsterbr
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kthxbye

~~~
subliminalpanda
Exactly what I did. Tried using reader mode (on FF), got a nice chuckle.

~~~
bittercynic
Blocking js from cityam.com fixes it.

~~~
subliminalpanda
Good to know.

Thanks!

