When to stop messaging and refer the client for medical care

Chat is useful for collecting concise information and arranging care, but poor at assessing the depth of tissue injury, infection or ocular trauma. Practitioners must recognise when messaging has stopped being useful.

Recognise high-priority symptoms promptly

Severe or increasing pain, blistering, separation of skin, grey or white discolouration, oozing, spreading redness, pus, fever, severe swelling or deterioration of general condition require prompt clinical evaluation. The exact level of urgency is determined by the approved escalation pathway and available medical services.

After possible eye exposure, new pain, photophobia, blurred vision, a change in the pupil or visual field, or any other visual symptom requires urgent ophthalmic evaluation. Do not ask the client simply to close the eye, apply a cosmetic product and report back later.

State the referral decision in plain language

The message contains the observable reason: "Due to increasing pain and blistering, this situation cannot be safely assessed via chat." Then the action, place or type of help, timing and method of calling emergency services if things get worse are indicated. If multiple options are available, priority is explained.

Do not say only “see a doctor just in case” when the signs require action today. The practitioner must still avoid diagnosis: statements such as “this is a second-degree burn” or “this is an infection” should come only from an appropriately qualified clinician after assessment. Clear referral advice does not require a diagnostic shortcut.

• Name the signs that make chat no longer suitable.
• Give a specific next step and required deadline.
• Check whether the client understands the referral instructions and can obtain help.
• Do not delay referrals for additional photos or internal approvals.

Do not attempt treatment while the client awaits care

The practitioner does not prescribe antibiotics, steroids, antihistamines, analgesics or other prescription medicines. Advise the client not to pop blisters, remove skin or apply unapproved products. Provide only pre-approved instructions that are appropriate to the situation and will not delay indicated medical care.

If the client asks for a diagnosis from a photograph, restate the limits of remote assessment. An additional image may document progression with consent, but it must not delay an indicated referral. If vision may be threatened or symptoms are deteriorating rapidly, urgent care remains the priority.

Document and follow up

The treatment record stores messages, time, signs, decision, referral instructions, confirmation of understanding and follow-up contact attempt. The responsible employee informs the manager or medical officer responsible for the policy and retains equipment and logs for analysis.

After the client receives care, the clinic does not ask them to repeat the diagnosis in a general chat. Information should arrive through a secure channel and only to the extent required. The review examines the procedure, device, cooling, protection, documentation and any delay in responding. The messaging exchange ends with referral, but the clinic’s responsibility for appropriate follow-up continues.