Patient Perspectives on Physician Accessibility Through Mobile Communication: A Cross-Sectional Study from a Tertiary Hospital in Pakistan

Patient Perspectives on Physician Accessibility Through Mobile Communication: A Cross-Sectional Study from a Tertiary Hospital in Pakistan | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Patient Perspectives on Physician Accessibility Through Mobile Communication: A Cross-Sectional Study from a Tertiary Hospital in Pakistan Varisha Madni, Syed Oun Abbas, Mubashirah Charolia, Amal Masood, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7665781/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 20 You are reading this latest preprint version Abstract Background: The rise of electronic communication has transformed healthcare delivery by improving accessibility and continuity of care. However, concerns remain regarding physician workload, patient safety, and the medicolegal implications of virtual consultations. This study aimed to assess patient satisfaction with having their physician’s phone number and to analyze contact patterns and behaviors associated with this practice. Methods: A cross-sectional Knowledge, Attitude, and Practice (KAP) study was conducted at Aga Khan University Hospital, Karachi. Patients aged ≥18 years with access to digital communication were recruited via convenience sampling. A bilingual (Urdu and English) 22-item questionnaire, developed from a literature review and expert feedback, was administered using Google Forms. Data were analyzed using SPSS v28 with multinomial logistic regression to identify significant associations. Results: Out of 209 respondents, 79.4% expressed interest in obtaining their physician’s contact number, and 86.6% believed it would improve the physician-patient relationship. Most (96.2%) viewed cell phones as an effective communication tool, though 50.2% were concerned about miscommunication. While 78.9% would limit calls to emergencies, 21.1% would contact physicians freely. Concerns about intrusion into physicians' private time (72.2%) and clinical workflow (64.1%) were prominent. Notably, 84.2% believed physicians were legally liable for phone consultation errors. Education level was significantly associated with contact patterns, with patients of lower educational backgrounds more likely to use phone calls over digital messaging platforms. Conclusion: Patients show a strong preference for direct phone communication with physicians, driven by perceived improvements in trust and security. However, this may increase physician burden and medico-legal risk. Structured consultation hours, digital literacy initiatives, and fair compensation models may help balance patient access with professional boundaries in digital healthcare settings. Patients perception tele-medicine phone consultations online consultation Introduction Electronic communication has undeniably become the cornerstone of modern society, dominating nearly every facet of human interaction. From the swift exchange of information via emails and instant messaging platforms to the seamless connectivity offered by social media networks, electronic communication has revolutionized the way people connect and communicate. In healthcare settings the growth of electronic media is propagated by the belief that it can improve the ease of access to, quality of, and efficiency of delivering healthcare services (1). In the present day, patients are able to connect with their doctors through cell phones or email. Communication through smartphones has the potential to improve access to healthcare, promote continuation of care, and reduce both the travel and time burdens on patients (2). Previous studies have also proved that enhanced communication fosters both higher quality of healthcare and greater patient satisfaction (3). Patients who visit primary care clinics also frequently contact their physicians by phone. Studies have shown that phone consultations can be an effective way to address patient concerns and avoid unnecessary clinical visits (4). While electronic media consultations can enhance patient access and reduce waiting times, they may also increase physicians' workload and intrude on their personal time (5). Additionally, virtual consultations may carry a higher risk of miscommunication, potentially leading to unintended outcomes and patient harm. The medico-legal implications of such consultations remain unclear, as existing laws and guidelines are limited and insufficiently defined. This study aims to evaluate patients’ satisfaction on being provided with their physicians contact number, and the behaviors and contacting patterns of the patients in this regard. Methods Study Design, Inclusion & Exclusion Criteria: This cross-sectional Knowledge, Attitude, and Practice (KAP) study was conducted among patients who presented to the Aga Khan University Hospital, Karachi, Pakistan. Patients fulfilling the following criteria were included in the study: [1] those aged 18 years and above, [2] those with a mobile phone or a means of communication with their doctor, and [3] those with sufficient language reading and writing skills. Patients were excluded if: [1] they were under 18 years old, [2] lacked digital communication means with their doctor, or [3] had insufficient language reading and writing skills. Questionnaire: A comprehensive literature search was conducted as the foundation for developing a questionnaire (3). The questionnaire consisted of 22 items covering patient demographics and their perspectives on physicians providing their phone numbers. Patients were asked about their opinion on the relationship between possession of contact and physician-patient relationship, strain on physicians’ time, contact frequency and scheduling, medio-legal aspects and safety concerns. The questionnaire ended with an inquiry about any past experience pertinent to the study. The questionnaire was refined based on feedback from a senior expert and was made bilingual (Urdu and English) to ensure accessibility for the local population. Sample Size: The sample size was calculated using the "OpenEpi Sample Size Calculator." The anticipated percentage for patient attitude was taken as 88% (4) with a 95% confidence interval, a design effect of 1, and a default population size of 1,000,000. The estimated sample size was 163 patients, and after applying a 10% inflation rate, the final sample size was calculated as 179 patients. Data Collection: The questionnaire was administered via Google Forms. Approval was obtained from the Disciplinary Review Committee (DRC) and exemption from Ethical Review Committee (ERC) at the Aga Khan University Hospital. Patients meeting the inclusion criteria were identified around Aga Khan University Hospital. Authors MC and AM assisted in data collection by facilitating the completion of all forms. The data collected was systematically managed using Google Sheets. Data Analysis: The data was analyzed using IBM SPSS Statistics software (version 28). Categorical variables were presented as frequencies and percentages. Associations between variables were assessed using multinomial logistic regression. A 95% confidence interval was used throughout the analysis, and a p-value of less than 0.05 was considered statistically significant. Results A total of 209 patients were interviewed, including 135 females (64.6%) and 74 males (35.4%), with a mean age of 18.95 years (SD 10.213). The majority were residents of Karachi, and detailed sociodemographic information was provided in Table 1. Most patients (166, 79.4%) were interested in getting their physician’s phone number, 66 (31.6%) had no objection, while 13 (31.6%) were not interested. Additionally, 181 (86.6%) believed that having their physician’s phone number would have improved the physician-patient relationship, and 191 (91.4%) felt it would have provided a greater sense of security, even if they did not use it later. A large majority (201, 96.2%) considered cell phones an effective means of communication, while only 6 (2.9%) disagreed. About half (105, 50.2%) thought there was a risk of miscommunication, whereas 92 (44%) saw no such risk. Most patients (165, 78.9%) said they would have used the number only in emergencies, but 44 (21.1%) would have called whenever they needed a consultation. Regarding responsibility, 176 (84.2%) believed the physician was legally responsible for any errors made during phone consultations, while 15 (7.2%) disagreed. When asked about calling times, 145 (69.4%) preferred contacting their physician only at appointed hours, 40 (19.1%) would have called during daytime except weekends, and 23 (11%) said they would have called at any time. More than half (151, 72.2%) believed that calling physicians could have interfered with their private time, and 134 (64.1%) thought it might have disrupted clinic work. Additionally, 87 (41.6%) felt a physician should have responded within an hour of a patient’s query. Most patients (178, 85.2%) believed additional pay for phone consultations would have encouraged physicians to share their contact details. Likewise, 191 (91.4%) supported the idea of dedicated consultation hours to improve accessibility. More than half (134, 64.1%) had previously asked for their physician’s phone number, and 127 (60.8%) still had it. Among those who had experienced online consultations, 144 (68.9%) were satisfied, while 20 (9.6%) were dissatisfied. (Table 2) Multinomial logistic regression showed that education level significantly influenced the likelihood of contacting physicians. Patients with high school education or less were 4.499 times more likely to have contacted physicians via WhatsApp compared to graduates (p = 0.07). The likelihood of contacting physicians via phone was much higher in this group (OR = 24.50, p < 0.001), making this a highly significant association. Undergraduates were 1.487 times more likely to have contacted physicians via WhatsApp, though this was not significant (p = 0.39). However, they were 6.049 times more likely to have contacted physicians via phone, and this association was statistically significant (p = 0.012). No significant associations were found between age or gender and physician contact via WhatsApp or phone calls. (Table 3) Discussion This study aimed to understand patient preferences and concerns regarding physician accessibility through mobile phone communication. A majority of patients (79.4%) were interested in obtaining their physician’s phone number, with 86.6% believing direct access would strengthen the physician-patient relationship, and 91.4% feeling it would provide a greater sense of security, regardless of whether they actually used the number. These findings align with previous studies showing that improved accessibility fosters trust and continuity of care between patients and physicians (6). While most patients (96.2%) considered cell phones an effective communication tool, half (50.2%) still had concerns about miscommunication. Additionally, many worried about potential disruptions to physicians' personal time (72.2%) and clinic hours (64.1%). This suggests that although mobile consultations offer convenience, in-person interactions remain highly valued. It also reinforces strong support (91.4%) for structured consultation hours to manage phone-based communication more effectively. Furthermore, a significant number of patients (85.2%) believed financial incentives could encourage physicians to share their contact details, highlighting the need for appropriate compensation. A large portion (84.2%) believed physicians are legally responsible for any errors made during phone consultations. While international guidelines, such as the American Medical Association (AMA) guidelines for patient-physician electronic communication (7), and local regulations, including the Sindh Telemedicine and Telehealth Act (8) and Policy for Telemedicine in Pakistan (9) , provide some direction, there remains a need for more refined guidelines addressing all medicolegal aspects of online consultations. Interestingly, education level significantly influenced communication preferences. Patients with a high school education or less were 24.5 times more likely to contact physicians via phone compared to graduates, while undergraduates were 6.049 times more likely. This suggests that less-educated patients may rely more on direct calls due to limited familiarity with alternative digital platforms like WhatsApp. While high school-educated patients were 4.499 times more likely to use WhatsApp for physician communication, this association was weaker and not statistically significant. This could indicate that WhatsApp is more commonly used by younger or more tech-savvy individuals, whereas phone calls remain the preferred method for those with lower educational backgrounds. Conclusion Our findings suggest a strong patient preference for direct physician communication, particularly through phone calls. However, we must consider the risk of miscommunication and physician burden. Implementing structured consultation hours and financial incentives may help balance accessibility with professional boundaries. Additionally, education level plays a significant role in communication preferences, indicating that targeted interventions, such as digital literacy programs, may facilitate more efficient communication methods. Future studies should explore physician perspectives and evaluate strategies to integrate and optimize patient-physician communication in an increasingly digitalized era. Limitations This study has several limitations. Since all participants were from a private hospital, they likely represent a specific socio-economic group, meaning the findings may not apply to individuals from different financial backgrounds. Additionally, as the study was conducted in a metropolitan city, the results may not reflect the preferences of those in less developed areas. Lastly, the study’s limited geographical scope prevents the findings from being generalized to the entire population. Declarations Ethics Approval and Participation Consent Ethical approval for this study was obtained from the Disciplinary Review Committee (DRC) at Aga Khan University Hospital, Karachi. The research was conducted in accordance with the Declaration of Helsinki. The study received exemption from the Ethical Review Committee (ERC). All participants provided informed consent prior to inclusion in the study. Consent for Publication Not applicable as this study does not include any identifiable personal data. Availability of data and materials The datasets generated and analyzed during the current study have been provided in tabular form in the article, they are also available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding No Funding was required for the execution of this study. Authors' contributions VM - Topic conception, data analysis, initial draft of manuscript, revision of manuscript. SOA - Topic conception, initial draft of manuscript, revision of manuscript. MC - Data collection, initial manuscript writing. AM - Data collection, initial manuscript writing. HS - Topic conception, revision of manuscript. Acknowledgements Not Applicable. References Castrén J, Niemi M, Virjo I. Use of email for patient communication in student health care: a cross-sectional study. BMC Med Inform Decis Mak. 2005 Jan 27;5(1):2. Telephone consulting in primary care: a triangulated qualitative study of patients and providers | British Journal of General Practice [Internet]. [cited 2025 Feb 24]. Available from: https://bjgp.org/content/59/563/e209 Peleg R, Nazarenko E. Providing cell phone numbers and e-mail addresses to patients: The patient’s perspective, a cross sectional study. Isr J Health Policy Res. 2012 Aug 28;1(1):32. Elnicki DM, Ogden P, Flannery M, Hannis M, Cykert S. Telephone Medicine for Internists. J Gen Intern Med. 2000 May;15(5):337–43. Providing cell phone numbers and email addresses to Patients: the physician’s perspective | BMC Research Notes | Full Text [Internet]. [cited 2025 Mar 4]. Available from: https://bmcresnotes.biomedcentral.com/articles/10.1186/1756-0500-4-76 (PDF) Continuity of Care and Trust in One’s Physician: Evidence from Primary Care in the United States and the United Kingdom. ResearchGate [Internet]. 2024 Oct 22 [cited 2025 Feb 24]; Available from: https://www.researchgate.net/publication/12131082_Continuity_of_Care_ and_Trust_in_One's_ Physician_Evidence_from_ Primary_Care_in_the_United_States_and_the_United_Kingdom Electronic Communication with Patients | AMA-Code [Internet]. [cited 2025 Feb 24]. Available from: https://code-medical-ethics.ama-assn.org/ethics-opinions/electronic-communication-patients Welcome to the Website of Provincial Assembly of Sindh [Internet]. [cited 2025 Feb 24]. Available from: http://www.pas.gov. pk/index.php/acts/details/en/32/487 https://nhsrc.gov.pk/SiteImage/M isc/files/FinalPolicy%20for%20Tele medicine%20in%20Pakistan%20(1)(1).pdf Tables Table 1: Patient Characteristics Parameter N (209) % Mean Standard Deviation Gender - - Female 135 59.2 Male 74 32.5 Total 209 100 Age_groups 18.95 10.213 =<25 159 69.7 26-40 43 18.9 41-65 26 11.4 Total 209 100 Education - - Till High School 85 37.3 Undergraduate 72 31.6 Graduate 50 21.9 Total 207 90.8 Table 2 and 3 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table23.docx PatientsPerspectiveQuestionnaire.docx Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 23 Dec, 2025 Reviews received at journal 22 Dec, 2025 Reviewers agreed at journal 22 Dec, 2025 Reviewers agreed at journal 22 Dec, 2025 Reviews received at journal 22 Dec, 2025 Reviewers agreed at journal 22 Dec, 2025 Reviewers agreed at journal 20 Dec, 2025 Reviewers agreed at journal 13 Dec, 2025 Reviewers agreed at journal 15 Nov, 2025 Reviewers agreed at journal 09 Nov, 2025 Reviews received at journal 13 Oct, 2025 Reviewers agreed at journal 13 Oct, 2025 Reviews received at journal 12 Oct, 2025 Reviewers agreed at journal 12 Oct, 2025 Reviewers agreed at journal 10 Oct, 2025 Reviewers invited by journal 10 Oct, 2025 Editor invited by journal 09 Oct, 2025 Editor assigned by journal 07 Oct, 2025 Submission checks completed at journal 07 Oct, 2025 First submitted to journal 20 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Pakistan","fulltext":[{"header":"Introduction","content":"\u003cp\u003eElectronic communication has undeniably become the cornerstone of modern society, dominating nearly every facet of human interaction. From the swift exchange of information via emails and instant messaging platforms to the seamless connectivity offered by social media networks, electronic communication has revolutionized the way people connect and communicate. In healthcare settings the growth of electronic media is propagated by the belief that it can improve the ease of access to, quality of, and efficiency of delivering healthcare services (1).\u003c/p\u003e\n\u003cp\u003eIn the present day, patients are able to connect with their doctors through cell phones or email. Communication through smartphones has the potential to improve access to healthcare, promote continuation of care, and reduce both the travel and time burdens on patients (2). Previous studies have also proved that enhanced communication fosters both higher quality of healthcare and greater patient satisfaction (3). Patients who visit primary care clinics also frequently contact their physicians by phone. Studies have shown that phone consultations can be an effective way to address patient concerns and avoid unnecessary clinical visits (4).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhile electronic media consultations can enhance patient access and reduce waiting times, they may also increase physicians\u0026apos; workload and intrude on their personal time\u0026nbsp;(5). Additionally, virtual consultations may carry a higher risk of miscommunication, potentially leading to unintended outcomes and patient harm. The medico-legal implications of such consultations remain unclear, as existing laws and guidelines are limited and insufficiently defined.\u003c/p\u003e\n\u003cp\u003eThis study aims to evaluate patients\u0026rsquo; satisfaction on being provided with their physicians contact number, and the behaviors and contacting patterns of the patients in this regard. \u0026nbsp;\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cem\u003eStudy Design, Inclusion \u0026amp; Exclusion Criteria:\u003cbr\u003e\u003c/em\u003eThis cross-sectional Knowledge, Attitude, and Practice (KAP) study was conducted among patients who presented to the Aga Khan University Hospital, Karachi, Pakistan. Patients fulfilling the following criteria were included in the study: [1] those aged 18 years and above, [2] those with a mobile phone or a means of communication with their doctor, and [3] those with sufficient language reading and writing skills. Patients were excluded if: [1] they were under 18 years old, [2] lacked digital communication means with their doctor, or [3] had insufficient language reading and writing skills.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eQuestionnaire:\u003c/em\u003e\u003cbr\u003e\u0026nbsp;A comprehensive literature search was conducted as the foundation for developing a questionnaire (3). The questionnaire consisted of 22 items covering patient demographics and their perspectives on physicians providing their phone numbers. Patients were asked about their opinion on the relationship between possession of contact and physician-patient relationship, strain on physicians\u0026rsquo; time, contact frequency and scheduling, medio-legal aspects and safety concerns. The questionnaire ended with an inquiry about any past experience pertinent to the study. The questionnaire was refined based on feedback from a senior expert and was made bilingual (Urdu and English) to ensure accessibility for the local population.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSample Size:\u003cbr\u003e\u003c/em\u003eThe sample size was calculated using the \u0026quot;OpenEpi Sample Size Calculator.\u0026quot; The anticipated percentage for patient attitude was taken as 88% (4) with a 95% confidence interval, a design effect of 1, and a default population size of 1,000,000. The estimated sample size was 163 patients, and after applying a 10% inflation rate, the final sample size was calculated as 179 patients.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData Collection:\u003c/em\u003e\u003cbr\u003e\u0026nbsp;The questionnaire was administered via Google Forms. Approval was obtained from the Disciplinary Review Committee (DRC) and exemption from Ethical Review Committee (ERC) at the Aga Khan University Hospital. Patients meeting the inclusion criteria were identified around Aga Khan University Hospital. Authors MC and AM assisted in data collection by facilitating the completion of all forms. The data collected was systematically managed using Google Sheets.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData Analysis:\u003c/em\u003e\u003cbr\u003e\u0026nbsp;The data was analyzed using IBM SPSS Statistics software (version 28). Categorical variables were presented as frequencies and percentages. Associations between variables were assessed using multinomial logistic regression. A 95% confidence interval was used throughout the analysis, and a p-value of less than 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 209 patients were interviewed, including 135 females (64.6%) and 74 males (35.4%), with a mean age of 18.95 years (SD 10.213). The majority were residents of Karachi, and detailed sociodemographic information was provided in Table 1.\u003c/p\u003e\n\u003cp\u003eMost patients (166, 79.4%) were interested in getting their physician\u0026rsquo;s phone number, 66 (31.6%) had no objection, while 13 (31.6%) were not interested. Additionally, 181 (86.6%) believed that having their physician\u0026rsquo;s phone number would have improved the physician-patient relationship, and 191 (91.4%) felt it would have provided a greater sense of security, even if they did not use it later.\u003c/p\u003e\n\u003cp\u003eA large majority (201, 96.2%) considered cell phones an effective means of communication, while only 6 (2.9%) disagreed. About half (105, 50.2%) thought there was a risk of miscommunication, whereas 92 (44%) saw no such risk. Most patients (165, 78.9%) said they would have used the number only in emergencies, but 44 (21.1%) would have called whenever they needed a consultation. Regarding responsibility, 176 (84.2%) believed the physician was legally responsible for any errors made during phone consultations, while 15 (7.2%) disagreed.\u003c/p\u003e\n\u003cp\u003eWhen asked about calling times, 145 (69.4%) preferred contacting their physician only at appointed hours, 40 (19.1%) would have called during daytime except weekends, and 23 (11%) said they would have called at any time. More than half (151, 72.2%) believed that calling physicians could have interfered with their private time, and 134 (64.1%) thought it might have disrupted clinic work. Additionally, 87 (41.6%) felt a physician should have responded within an hour of a patient\u0026rsquo;s query.\u003c/p\u003e\n\u003cp\u003eMost patients (178, 85.2%) believed additional pay for phone consultations would have encouraged physicians to share their contact details. Likewise, 191 (91.4%) supported the idea of dedicated consultation hours to improve accessibility. More than half (134, 64.1%) had previously asked for their physician\u0026rsquo;s phone number, and 127 (60.8%) still had it. Among those who had experienced online consultations, 144 (68.9%) were satisfied, while 20 (9.6%) were dissatisfied. (Table 2)\u003c/p\u003e\n\u003cp\u003eMultinomial logistic regression showed that education level significantly influenced the likelihood of contacting physicians. Patients with high school education or less were 4.499 times more likely to have contacted physicians via WhatsApp compared to graduates (p = 0.07). The likelihood of contacting physicians via phone was much higher in this group (OR = 24.50, p \u0026lt; 0.001), making this a highly significant association. Undergraduates were 1.487 times more likely to have contacted physicians via WhatsApp, though this was not significant (p = 0.39). However, they were 6.049 times more likely to have contacted physicians via phone, and this association was statistically significant (p = 0.012). No significant associations were found between age or gender and physician contact via WhatsApp or phone calls. (Table 3)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to understand patient preferences and concerns regarding physician accessibility through mobile phone communication. A majority of patients (79.4%) were interested in obtaining their physician\u0026rsquo;s phone number, with 86.6% believing direct access would strengthen the physician-patient relationship, and 91.4% feeling it would provide a greater sense of security, regardless of whether they actually used the number. These findings align with previous studies showing that improved accessibility fosters trust and continuity of care between patients and physicians (6).\u003c/p\u003e\n\u003cp\u003eWhile most patients (96.2%) considered cell phones an effective communication tool, half (50.2%) still had concerns about miscommunication. Additionally, many worried about potential disruptions to physicians\u0026apos; personal time (72.2%) and clinic hours (64.1%). This suggests that although mobile consultations offer convenience, in-person interactions remain highly valued. It also reinforces strong support (91.4%) for structured consultation hours to manage phone-based communication more effectively. Furthermore, a significant number of patients (85.2%) believed financial incentives could encourage physicians to share their contact details, highlighting the need for appropriate compensation.\u003c/p\u003e\n\u003cp\u003eA large portion (84.2%) believed physicians are legally responsible for any errors made during phone consultations. While international guidelines, such as the American Medical Association (AMA) guidelines for patient-physician electronic communication (7), and local regulations, including the Sindh Telemedicine and Telehealth Act (8) and Policy for Telemedicine in Pakistan (9) , provide some direction, there remains a need for more refined guidelines addressing all medicolegal aspects of online consultations.\u003c/p\u003e\n\u003cp\u003eInterestingly, education level significantly influenced communication preferences. Patients with a high school education or less were 24.5 times more likely to contact physicians via phone compared to graduates, while undergraduates were 6.049 times more likely. This suggests that less-educated patients may rely more on direct calls due to limited familiarity with alternative digital platforms like WhatsApp. While high school-educated patients were 4.499 times more likely to use WhatsApp for physician communication, this association was weaker and not statistically significant. This could indicate that WhatsApp is more commonly used by younger or more tech-savvy individuals, whereas phone calls remain the preferred method for those with lower educational backgrounds.\u003c/p\u003e\n"},{"header":"Conclusion","content":"\u003cp\u003eOur findings suggest a strong patient preference for direct physician communication, particularly through phone calls. However, we must consider the risk of miscommunication and physician burden. Implementing structured consultation hours and financial incentives may help balance accessibility with professional boundaries. Additionally, education level plays a significant role in communication preferences, indicating that targeted interventions, such as digital literacy programs, may facilitate more efficient communication methods. Future studies should explore physician perspectives and evaluate strategies to integrate and optimize patient-physician communication in an increasingly digitalized era.\u003c/p\u003e\n"},{"header":"Limitations","content":"\u003cp\u003eThis study has several limitations. Since all participants were from a private hospital, they likely represent a specific socio-economic group, meaning the findings may not apply to individuals from different financial backgrounds. Additionally, as the study was conducted in a metropolitan city, the results may not reflect the preferences of those in less developed areas. Lastly, the study\u0026rsquo;s limited geographical scope prevents the findings from being generalized to the entire population.\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthics Approval and Participation Consent\u003cbr\u003e\u003c/em\u003eEthical approval for this study was obtained from the Disciplinary Review Committee (DRC) at Aga Khan University Hospital, Karachi. The research was conducted in accordance with the Declaration of Helsinki. The study received exemption from the Ethical Review Committee (ERC). All participants provided informed consent prior to inclusion in the study.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for Publication\u003c/em\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Not applicable as this study does not include any identifiable personal data.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of data and materials\u003cbr\u003e\u003c/em\u003eThe datasets generated and analyzed during the current study have been provided in tabular form in the article, they are also available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003cbr\u003e\u0026nbsp;The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u003cbr\u003e\u003c/em\u003eNo Funding was required for the execution of this study.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors\u0026apos; contributions\u003cbr\u003e\u003c/em\u003eVM -\u003cem\u003e\u0026nbsp;\u003c/em\u003eTopic conception, data analysis, initial draft of manuscript, revision of manuscript.\u003cem\u003e\u003cbr\u003e\u0026nbsp;\u003c/em\u003eSOA - Topic conception, initial draft of manuscript, revision of manuscript.\u003cem\u003e\u003cbr\u003e\u0026nbsp;\u003c/em\u003eMC - Data collection, initial manuscript writing.\u003cem\u003e\u003cbr\u003e\u0026nbsp;\u003c/em\u003eAM - Data collection, initial manuscript writing.\u003cem\u003e\u003cbr\u003e\u0026nbsp;\u003c/em\u003eHS - Topic conception, revision of manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgements\u003cbr\u003e\u003c/em\u003eNot Applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCastr\u0026eacute;n J, Niemi M, Virjo I. Use of email for patient communication in student health care: a cross-sectional study. BMC Med Inform Decis Mak. 2005 Jan 27;5(1):2. \u003c/li\u003e\n\u003cli\u003eTelephone consulting in primary care: a triangulated qualitative study of patients and providers | British Journal of General Practice [Internet]. [cited 2025 Feb 24]. Available from: https://bjgp.org/content/59/563/e209\u003c/li\u003e\n\u003cli\u003ePeleg R, Nazarenko E. Providing cell phone numbers and e-mail addresses to patients: The patient\u0026rsquo;s perspective, a cross sectional study. Isr J Health Policy Res. 2012 Aug 28;1(1):32. \u003c/li\u003e\n\u003cli\u003eElnicki DM, Ogden P, Flannery M, Hannis M, Cykert S. Telephone Medicine for Internists. J Gen Intern Med. 2000 May;15(5):337\u0026ndash;43. \u003c/li\u003e\n\u003cli\u003eProviding cell phone numbers and email addresses to Patients: the physician\u0026rsquo;s perspective | BMC Research Notes | Full Text [Internet]. [cited 2025 Mar 4]. Available from: https://bmcresnotes.biomedcentral.com/articles/10.1186/1756-0500-4-76\u003c/li\u003e\n\u003cli\u003e(PDF) Continuity of Care and Trust in One\u0026rsquo;s Physician: Evidence from Primary Care in the United States and the United Kingdom. ResearchGate [Internet]. 2024 Oct 22 [cited 2025 Feb 24]; Available from: https://www.researchgate.net/publication/12131082_Continuity_of_Care_\nand_Trust_in_One\u0026apos;s_\nPhysician_Evidence_from_\nPrimary_Care_in_the_United_States_and_the_United_Kingdom\u003c/li\u003e\n\u003cli\u003eElectronic Communication with Patients | AMA-Code [Internet]. [cited 2025 Feb 24]. Available from: https://code-medical-ethics.ama-assn.org/ethics-opinions/electronic-communication-patients\u003c/li\u003e\n\u003cli\u003eWelcome to the Website of Provincial Assembly of Sindh [Internet]. [cited 2025 Feb 24]. Available from: http://www.pas.gov.\npk/index.php/acts/details/en/32/487\u003c/li\u003e\n\u003cli\u003ehttps://nhsrc.gov.pk/SiteImage/M\nisc/files/FinalPolicy%20for%20Tele\nmedicine%20in%20Pakistan%20(1)(1).pdf\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1:\u0026nbsp;\u003c/strong\u003ePatient Characteristics\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameter\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN (209)\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStandard Deviation\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;- \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;-\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003eFemale\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e135\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e59.2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003eMale\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e74\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e32.5\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003eTotal\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e209\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e100\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge_groups\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e18.95\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e10.213\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003e=\u0026lt;25\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e159\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e69.7\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003e26-40\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e43\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e18.9\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003e41-65\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e26\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e11.4\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003eTotal\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e209\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e100\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;-\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;-\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003eTill High School\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e85\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e37.3\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003eUndergraduate\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e72\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e31.6\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003eGraduate\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e50\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e21.9\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003eTotal\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e207\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e90.8\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 2 and 3 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Patients perception, tele-medicine, phone consultations, online consultation ","lastPublishedDoi":"10.21203/rs.3.rs-7665781/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7665781/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Background: The rise of electronic communication has transformed healthcare delivery by improving accessibility and continuity of care. However, concerns remain regarding physician workload, patient safety, and the medicolegal implications of virtual consultations. This study aimed to assess patient satisfaction with having their physician’s phone number and to analyze contact patterns and behaviors associated with this practice.\n\nMethods:\nA cross-sectional Knowledge, Attitude, and Practice (KAP) study was conducted at Aga Khan University Hospital, Karachi. Patients aged ≥18 years with access to digital communication were recruited via convenience sampling. A bilingual (Urdu and English) 22-item questionnaire, developed from a literature review and expert feedback, was administered using Google Forms. Data were analyzed using SPSS v28 with multinomial logistic regression to identify significant associations.\n\nResults:\nOut of 209 respondents, 79.4% expressed interest in obtaining their physician’s contact number, and 86.6% believed it would improve the physician-patient relationship. Most (96.2%) viewed cell phones as an effective communication tool, though 50.2% were concerned about miscommunication. While 78.9% would limit calls to emergencies, 21.1% would contact physicians freely. Concerns about intrusion into physicians' private time (72.2%) and clinical workflow (64.1%) were prominent. Notably, 84.2% believed physicians were legally liable for phone consultation errors. Education level was significantly associated with contact patterns, with patients of lower educational backgrounds more likely to use phone calls over digital messaging platforms.\n\nConclusion: \nPatients show a strong preference for direct phone communication with physicians, driven by perceived improvements in trust and security. However, this may increase physician burden and medico-legal risk. Structured consultation hours, digital literacy initiatives, and fair compensation models may help balance patient access with professional boundaries in digital healthcare settings.","manuscriptTitle":"Patient Perspectives on Physician Accessibility Through Mobile Communication: A Cross-Sectional Study from a Tertiary Hospital in Pakistan","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-23 12:08:37","doi":"10.21203/rs.3.rs-7665781/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-23T07:37:37+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-22T06:44:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"44100855589755593545958776129619105219","date":"2025-12-22T06:29:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"266995172674326435091836183471258585671","date":"2025-12-22T05:40:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-22T05:26:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"249535899744555847048320123702489195918","date":"2025-12-22T05:02:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"321431971558601174021142582972952145328","date":"2025-12-20T13:12:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"231561579178237733665774509401337598567","date":"2025-12-13T14:57:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"52167689720176951981384831701691754058","date":"2025-11-15T16:37:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"130542084575839507237409961610313753250","date":"2025-11-09T12:47:21+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-13T05:58:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"136151193145552893537810553015271709149","date":"2025-10-13T05:03:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-12T18:49:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"291253958364492021383226630178520592779","date":"2025-10-12T08:30:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"51626757628519290801701805193841134265","date":"2025-10-10T08:02:21+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-10T07:05:14+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-09T06:43:56+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-07T10:16:08+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-07T10:15:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-09-20T19:02:13+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"082656f4-52f6-49fa-bcb7-98105c8a337c","owner":[],"postedDate":"October 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2025-12-23T07:53:16+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-23 12:08:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7665781","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7665781","identity":"rs-7665781","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}