The impact of the Internet on the doctor-patient relationship It also considers their perception of the extent of patients' Internet usage, the quality of the. The Impact of the Internet on the Doctor - Patient Relationship. Article (PDF Available) in Australasian Medical Journal 1(5) · May with Reads. Finally, it is unclear how health information on the Internet will affect the physician -patient relationship, the cornerstone of good medical care.
Even so, the early investment results show a scenario allowing an optimistic view of the sector WHO, The sector employs about one million people WHO, As reported by Seckinpatients are dissatisfied with their doctor—patient relationship.
These stated factors, coupled with concerns on medical care expenditure increase and the emergence of conflicting issues between users and healthcare service providers have generated renewed interest in studies and reflections on the doctor—patient relationship. In this context, particularly the changing dynamics of performance in the doctor—patient relationship, this article aims to identify and analyze the impact of Internet use, particularly on the human side of that relationship.
The discussion is relevant to the presence of new technologies influencing the quality of care and debates about the role of the physician in the current working environment. Most Internet searches performed by patients before their clinic appointment are directed to specific clinical conditions. Information is sought with the objective of dealing independently with their own medical care, thereby being able to decide whether there is a need for professional help or not, and in some cases, overcoming reluctance to disclose personal matters.
Searches may continue even after the appointment because of a lack of satisfaction with the most recent medical consultation or even to confirm the validity of what they have been told by their doctor. Major approaches to the doctor—patient relationship The role of medicine in the second half of this century has been re-analyzed within several perspectives.
He emphasized the need for medicine to recover the subjective elements of communication between doctor and patient that were improperly assumed by psychoanalysis and left aside by medicine, thus pursuing a path exclusively based on technical instrumentation and data objectivity.
Gregory Bateson, Watzlawick, and Jackson Watzlawick et al. Most of these studies are based on the work of Donabedian, who in the early s published several volumes and articles on this issue Donabedian, A survey by Boltanski dealt with doctor—patient communication in various regions of France.
Boltanski discusses the differences between scientific-medical knowledge and family-medical knowledge and relates these differences to the doctor—patient relationship. Another perspective presented by Russ et al. Among Brazilian authors, such as SallesSucupiraCoelho Filhoit is possible to observe that arguments related to this issue are discussed again; however, these have been in the form of essays presenting opinions or declaring theoretical inspirations.
Two works stand out as being based on a systematic analysis to a large extent.
At the time the study was conducted, the Brazilian population was served primarily by three systems operating in parallel: This research, in the view of the consumer, took into consideration physical conditions, accessibility, efficiency, professional availability, and medicines. This was evidence that these three big providers had different models for health care, which were recognized by the public, thus providing an option for them to choose the most suitable model to their needs in their search for care services, including relational dimension aspects.
He interviewed doctors with extensive clinical practice to examine the way they included technology in their professional activities. However, parallel to this social transformation, we can observe the valuing of science and the intellectualization of knowledge. Medicine would have gone through the universalization of its actions, having patients as the object of their cognition, and in such circumstances, social differences would be left aside, giving priority to the object of scientific wisdom.
In such conditions, the medical process is configured as a repetitive act of knowledge enabled by science, having thus entered the world of serial production, a factor which marks the industrial technology society Goodman, Confidence in the doctor—patient relationship The focus of power in health care is shifting: A number of studies focus on whether the Internet can actually empower patients and enrich the patient-doctor relationship Shoor and Lorig, ; Sinclair, Trust has been described as one of the scarcest medical products Attfield et al.
However, with the arrival of the information age, patients came under the influence of the digital revolution. The immediate reaction has been that confidence in the doctor is replaced by skepticism and discouragement.
Patients search on medical websites and then consult their doctors armed with that information. Grosseman and Stollhowever, warn that a large resistance from healthcare professionals has been noticed against the modification of the doctor—patient relationship dynamics in the age of information, owing to a bigger concern on the inconsistent and seldom reliable medical information on the Internet, the waste of the human factor, and the problematic perception of the informed patient.
Contribution of ICT in the Medical Field In a complex universe formed by multiple and diversified organizations, ICTs have become competitively instrumental in driving and positioning virtually any organization, often transforming the reality and essence of the business itself. Given the enormous potential, organizations are leading the development and application of ICTs, either through the optimization of internal works or by inducing changes at the business level, thereby capitalizing on ICT developments in order for them to become more dynamic and better qualified to innovation in response to market changes Hummel, Propelled at first through successive technological advances, in terms of equipment and software, then through an increasing recognition of its potential, ICTs have emerged from the gloomy condition of doing mainly automation tasks in organizations, in order to make an up-to-date assessment Hummel, as a determining factor for competitive positioning.
ICTs are the bedrock of contemporary organization. Currently, it is almost impossible to conceptualize an organization that does not use ICT; it would not be excessive to say that the effects of ICT have been and certainly will continue to be fully integrated in organizations Valle,whether from the point of view of incorporating these technologies into the value chain of the enterprise or from the point of view of establishing a competitive advantage.
As an important catalyst for change in the manner that work is performed, information technologies also play a key role in the health sector Hummel, As a whole, the advent of the Internet has led this industry to exploit ICTs in order to improve patient care in hospitals, increase the commercial effectiveness of institutions, and optimize communication between the various players in the sector MacGregor et al.
As MacGregor et al. For instance, Akersson et al. El-Sayed and Westrup suggest that ICT use in hospital practices improves communication, causing business effectiveness growth and contributing to new enterprise initiatives.
Seckin suggests that ICT supports and allows complex interactions between, for example, doctors, nurses, patients, and sometimes facilities. Hummel suggests that when ICT is applied to medical practices, it produces a change in procedures which result in a more effective final product. Goodman reports an increase in the financial income. Ray and Mukherjee note the use of ICT in management and planning development.
Other studies such as the ones by Lougheed and Ho et al. It becomes clear that, without an efficient and effective use of ICT, organizations cannot be efficient or competitive, and in most cases, they depend on these abilities to survive Hummel, Given the importance of the Internet today in the context of organizational development, it is essential to characterize the current reality in terms of its adoption in hospitals, in the interest of improving evaluation and future planning.
Technological Investment in the Health Sector An increasing worldwide emphasis in the health sector has been observed in recent years, mainly among Western countries and the United States, where a growth of per capita expenditures on health has been witnessed OECD, This change is related to many aspects of the contemporary society, including increase in life expectancy, and demand from people for a better quality of life and better health services.
LHD07 There was one page on it which was questions to ask your doctor which was one of the things I went looking for and I found somewhere else had represented it much better but as an idea it was really good. Especially when you go to see a consultant and you wait months and months for that sort of thing to happen and your mind is full of all sorts of stuff.
It's nice to go in with a written list or prepared list of things to ask. Heart disease group 2 The Internet provides easy access to medical information outside of the consultation. One informant explained how he had used the Internet to search for information about a particular drug so as to engage with the doctor about a previous prescribing decision.
This did not appear to be indicative of a lack of faith in, or attempt to undermine, the doctor, but rather a desire to have an informed discussion. EHD02 Something I've discovered recently for instance is — my mother is on a drug called Seroxat which has been in the papers a lot recently because of the bad side effects and she does have side effects and I'm, I personally am convinced that it's because of this particular drug.
[Impact of the internet on physician-patient relationship].
Well I was able to look up all the details about that you know, the whys and the wherefores and where it's banned and where it's not banned and then you know we can see the doctor about it and say well, should she, are you quite sure? Heart disease group 3 There was a general awareness on the part of respondents that there were limits to their GP's knowledge. For this reason respondents felt they had a responsibility to search for information.
I've had to do a lot for meself to find out different things and you know the doctors are not even as much aware. I mean they can't all be experts in the one thing Diabetes group 4 Respondents with Hepatitis C particularly expressed the view that GPs might not be well informed about their condition.
Hepatitis C group Practical advice and experiential knowledge relating to the day-to-day management of conditions and medical procedures was perceived by all groups to be very useful; beyond the doctor's expertise, but nevertheless easily accessible via the Internet. So that rather than reinventing the wheel it's sharing with other people and there are tips and tricks that you get from them that you just wouldn't get from a GP.
Just little practical things. Most people believe that there is some kind of Government, you know, shut your mouth — you know what I mean — it's kind of like the government are keeping it [treatments not available on the NHS] secret because of the impact on the health service — I mean it would devastate the health service if - LHCO4 Too expensive Hepatitis C group Perceived limitations of the Internet Even where there was the facility to consult a medical professional over the Internet, it was felt that any advice provided was limited by the fact that it was not based on the individual's medical records and knowledge of their past medical history.
LHD07 Any doctor or GP you ask over the Internet is going to be so, have such limited information they would be very reticent to give you opinions or advice. Their first thing would be to go to your GP or go to your doctor because they've got your full case notes. So if they could get over that barrier it would be useful but it's a big barrier to get over. R The fact that they wouldn't have information about you? LHD07 It's like these dial in things you hear on the radio, these sort of radio doctors and telephone doctors you hear, you know 99 times out of what they say is go to your GP.
Heart disease group 2 A particular concern was that information obtained via the Internet may not be considered as trustworthy as advice obtained directly from their doctor.
LHD06 I wouldn't trust a computer that much EHD04 Yeah and are people articulate enough to be able to put down their question properly in the first place as against speaking it they have got to write it haven't they? Heart disease group 3 Sharing information from the Internet There were reports that doctors positively encouraged people to search for information about their medical problems and potential treatment options. Which a lot of people do do, then you could put that data into the computer, and the doctor would have that when you see them LHD06 What your own doctor do you mean?
R Either your GP or your hospital doctor, you could choose LHD10 I think doctors tend to get annoyed when you start telling them your own self-diagnosis. Heart disease group 1 Respondents generally presented the Internet as a resource that supported and enhanced as opposed to challenged the therapeutic relationship and in keeping with this it was suggested that information found should be checked with the doctor.
LHDO5 As a sensible person Other respondents in the group challenged this, but the fact it was raised demonstrates that not every patient believes the Internet is a useful resource in this context. I mean why should a person write a question of a medical nature, a medical enquiry when all they've got to do is go to their own surgery and ask the doctor. EHD05 Well there are lots of reasons why they would do that, lots of reasons.
Heart disease group 3 Future uses of the Internet in health care Respondents suggested that a possible future use of Internet technology, saving time for both patients and practitioners, was performing automated tasks such as checking if test results are available, or using test results as a basis for informing people of the necessity for an appointment. It was also suggested that ongoing monitoring could be provided over the Internet.
There was particular exploration of this by the diabetes groups. R How would the website then give you an idea of how things were going? LAD02 Because if I'm diarising over a period of time, it would give you feedback it looks like from the programme, on basically that you would be able to look and to read about how you've done this week, how you've done next week when it's put it all together, 'cos as a process it will do it for you, which is really good and really helpful.
What is cyberchondria?
As opposed to you taking paper and pen and doing it, and you forget and then you — 'cos I can't remember at the end of the day everything that I've eaten, or whatever it is, and what I've done completely, you know, 'cos my brain's tired and you know, I'm just absolutely just at the end of the tab, and it takes too much. But if I had the programme, and I could just put in, dot in these true things as I went along, at the end of the week it's doing the work for me, calculating and saying: And you could look, and it says on it in printout, so that you could take it to your medical practitioner at the end - LAD04 Yes, that would be a really good idea.
LAD02 And that would be really useful because then they're sitting there going to you: It has been suggested that the Internet may alter the traditional imbalances in knowledge and power in the doctor-patient relationship [ 1320 ], however our data indicate that the effect is more complex. Rather we suggest that information obtained via the Internet supports existing therapeutic relationships.
The few accounts of searches that might contradict information from the consultation were not presented as attempts to challenge previous encounters but rather to clarify information provided or treatment decisions.
Crucially it is clear that patients viewed seeking information from the Internet as fundamentally different from gaining information from a face to face encounter with their doctor.
This was attributed to factors such as access to a full medical history and the humanity of dealing with a person face to face. This may have implications for the future direction and development of Internet interventions. There has been a great deal of attention in the literature concerning patient activism in the consultation.
There was some discussion and acceptance of the idea that doctors cannot be experts in everything and that patients therefore need to take some responsibility for finding out about their particular problems. It is, however, worth noting that activism outside of the consultation is lower risk in terms of upsetting the rules of interaction in consultations and therefore is arguably an attractive option for patients.
The Internet was perceived to be particularly valuable in this endeavour as information could be easily accessed as necessary. There was some interest in the potential of the Internet for services such as automated test results and routine monitoring. Yet this has to be considered alongside concerns raised about bringing information into the consultation. The Internet is unlikely to become an openly integrated part of medical interaction until both patients and practitioners can agree on the role the patient, in relation to introducing information into the consultation be it from the news media, books, or the Internet, should play and practitioners make it clear to patients that both the use, and discussion of the use, of information sources from outside the consultation are legitimate.
[Impact of the internet on physician-patient relationship].
Conclusion Although the literature identifies possible tensions that may be caused by patients' access to information via the Internet, generally the Internet was perceived as a support, as opposed to a challenge, to medical practice. There was a continuing and strong awareness of the value of medical expertise.
The accounts here do not in any way suggest a desire to disrupt the existing balance of power, or roles, in the consultation.
Limitations Our data are limited to people who were suffering from a chronic condition.