Doctor patient relationship: changing dynamics in the information age. Akerkar SM, Bichile LS community-based studies, even clinic-based studies have. Request PDF on ResearchGate | On Apr 1, , S M Akerkar and others published Doctor patient relationship: Changing dynamics in the information age. Changing dynamics of the physician–patient relationship. .. in intersection of Web technology with actual physician–patient the information age .
Because it provides access to a wealth of information that was not previously available to the general public, it enables patients to increase their knowledge significantly; this may result in patients who have greater self-confidence in their abilities to take an active role in interactions with their physicians, to cope with health conditions, and to participate in treatments McMullan, Due to the sheer volume of information contained on the Internet, patients are able to learn about even the rarest of conditions and to discover the latest experimental biomedical treatments or alternative therapies for conditions Anderson et al.
Patients can now contact medical experts and specialists on an international scale, rather than having to rely on those in the local area Anderson et al. However, increased use of the Internet to meet the demand for health information is not without its disadvantages. The amount of information in general, and health information in particular, available online is vast and unregulated.
This situation may be overwhelming to some individuals, causing more feelings of anxiety than of control. Conflicting information may be presented on different websites, as well as information that is simply inaccurate, leading to patient confusion. The accuracy of the information available on the Internet and the credibility of websites are often difficult to determine, especially for inexperienced users, and this may lead to incorrect self-diagnosis and the use of potentially dangerous treatments McMullan, There are a variety of reasons why patients turn to the Internet to provide health information despite the dangers of conflicting or inaccurate information.
Since information pervades all activities of daily life, patients often view searching the Internet for health information as a natural thing and may do so without any real conscious thought guiding their actions Kivits, ; Spitzer, In an effort to be responsible, many patients actively seek information in preparation for an appointment with a physician Kivits, ; Murray, Lo, Pollack, Donelan, Catania, White, et al.
Many other patients are simply looking for external confirmation of or supplemental information to the information that they have received from their physicians Kivits, or reassurance that they know everything there is to know about their conditions McMullan, Some desire or need information different from that which they have received or are looking to widen their options, both in terms of treatments and health care providers Kivits, Although many patients use the Internet to access health information for positive reasons, there are also negative motivators for doing so.
There is a growing distrust of physicians in Western society Akerkar and Bichile, ; Spitzer,and some patients expect more from their encounters with their physicians than they feel they receive Erdem and Harrison-Walker, ; Kivits, These patients may not feel that physicians spend enough time with them, listen to them closely, or address their concerns satisfactorily Kivits, They may feel that they are lacking in information generally and that physicians are not meeting their needs for information Anderson et al.
All of these feelings can result in dissatisfaction and frustration, leading to the search for alternate sources of information. Finally, and dangerously, some people use the Internet for self-diagnosis, anticipating that they should be able to take care of themselves and that doing so is more convenient and will save them time and money Erdem and Harrison-Walker, Regardless of their reasons for doing so, patients are increasingly able to access health information via the Internet and are taking advantage of this opportunity.
Patients are becoming both more informed and more misinformed, with potentially valuable information applicable to their concerns and with information that is inappropriate or even inaccurate. A significant percentage of patients are sharing their new, Internet-derived information with their physicians and are using it to assist them in making important health decisions Broom, b.
This is changing the dynamic that exists between patients and physicians, as they seek or are forced into new roles and responsibilities within the existing frameworks of their relationships. Patient views Overall, patients tend to view their use of the Internet to locate health information very positively and feel that it provides them with a number of benefits.
Patients feel that the information they collect enables them to improve their health generally and their understanding of their condition specifically Kivits, Many patients also feel that, because they have more information at their disposal, they are more confident and feel more comfortable talking to their physicians about their concerns Murray, Lo, Pollack, Donelan, Catania, White, et al. Use of the Internet as a provider of health information both stems from and results in patients having changing expectations of physicians McMullan, Patients often expect much more from physicians today than may have been the case in the past and search for alternative sources of information when they feel that physicians are not living up to their expectations.
Furthermore, patients feel that the fact that they can access health information themselves necessitates that physicians remain up-to-date on the latest research and treatment options Murray, Lo, Pollack, Donelan, Catania, White, et al.
Benefits aside, some patients also acknowledge that there are negative aspects to the increased availability of health information. Also, the information on the Internet is not always reliable; patients are aware of and concerned about this Murray, Lo, Pollack, Donelan, Catania, White, et al. However, although there is a sense of concern about their ability to judge Kivits,many feel that they are able to determine the value of the information they find Broom, b; Hardey, It has been found that about half of the people who find information that they feel is relevant to their health share it with their physicians.
Patients feel very positive about the information they have found, feel positive about sharing it with their physicians, and feel that the reactions they get from their physicians are positive as well Murray, Lo, Pollack, Donelan, Catania, White, et al.
Doctor patient relationship: changing dynamics in the information age.
Physician views As the other participants in these interactions, physicians also have a range of views regarding the value of Internet-accessed health information, and their views may be even more influential in determining how the information affects the physician-patient relationship. Their views are again both positive and negative, and this distinction often depends on the points in the physician-patient interactions at which patients seek the information and to what use they put it.
In theory, physicians may view the increase in information in a positive light Murray, Lo, Pollack, Donelan, Catania, Lee, et al. Physicians agree that it may improve the confidence of patients, increasing their comfort levels in physician-patient interactions, and that this, combined with the increases in knowledge, can lead to more sophisticated and intelligent interactions Akerkar and Bichile, ; Broom, a; Gerber and Eiser, In practice, however, physicians often have a number of significant concerns that can overshadow their beliefs in the potential benefits of Internet use.
Physicians tend to be more skeptical of patients using the Internet to search for health information than are patients. They are perhaps most significantly concerned about the volume, nature, and accuracy of the health information found Ahmad et al. Physicians worry that patients will become overwhelmed by the amount of information available on the Internet or that they will not be unable to understand it.
Depending on the websites viewed, information can be highly technical, complex, and detailed. Patients will often visit websites aimed specifically at physicians in their searches for health information because they feel that the information provided on other sites is too simple. Physicians fear that patients, lacking medical training and expertise, may believe that they understand the information when in reality they have interpreted it incorrectly McMullan, Physicians also worry about the danger of patients engaging in self-diagnosis using the information they have found Erdem and Harrison-Walker, ; McMullan, Self-diagnosis has the potential to cause significant harm if patients treat themselves based on inaccurate information or incorrect diagnoses.
Furthermore, physicians worry that self-diagnosing will deter patients from seeing physicians about their conditions, since they feel as though they have taken care of the problems. If this is the case, any misinformation or incorrect treatment may not be corrected Anderson et al. These physicians may feel that, by introducing health information into physician-patient encounters, patients are challenging their authority and questioning their medical expertise McMullan, ; Murray, Lo, Pollack, Donelan, Catania, Lee, et al.
This can cause the physicians to feel threatened Anderson et al. Some physicians also feel that they do not have the time to deal properly with the information that is brought into the encounters McMullan, ; Murray, Lo, Pollack, Donelan, Catania, Lee, et al.
Physicians frequently have limited time to spend with each patient and may view even implied requests for more time unfavorably Ahmad et al. Finally, some physicians feel unprepared to deal with patients who demand inappropriate treatments, specific treatments, or treatments that are very new and not yet available; this can cause significant amounts of discomfort for these physicians Anderson et al. Patient use of the Internet as a source of health information is also creating a feeling among physicians that they have a responsibility to interpret the information for their patients and to correct any false information the patients may have found Ahmad et al.
Some physicians welcome this as a way to give patients more control over decision-making, but some may be resentful of the amount of time it takes to review the information, unwilling or unable to spend this extra time with the patients, or uncomfortable with the new power dynamics in the relationships Ahmad et al. Most physicians have experienced patients who have brought information from the Internet to an appointment Malone et al. However, if they feel that the information is inaccurate or irrelevant, reactions are more negative Murray, Lo, Pollack, Donelan, Catania, Lee, et al.
Physicians also react more positively to information that is gathered after initial appointments by patients who want to educate themselves about their diagnoses, rather than before these appointments by those who engage in self-diagnosis Ahmad et al. Relationships may be further improved if patients feel as though their physicians respect them and judge them to be competent Broom, b. When these feelings are nurtured, relationships may come to feel more like partnerships, and patients may become more likely to trust their physicians, to accept their diagnoses and treatment recommendations as appropriate, and to comply with their instructions, potentially improving health outcomes Erdem and Harrison-Walker, However, due to a number of factors, the changes in the physician-patient relationship may not always be this positive.
Relationships may become strained if patients feel that they are more knowledgeable than their physicians Anderson et al. Strain may also occur if physicians feel as though their authority or medical expertise is being challenged, especially if there are discrepancies between what the physicians and the patients view as appropriate treatments Anderson et al.
Disagreements and negative reactions on the part of physicians can have negative effects on the health care provided and, ultimately, the health outcomes for the patients. Many physicians have developed a number of strategies for dealing with additional health information and with the patients bringing it to their attention; these may serve to either strengthen or weaken the physician-patient relationship depending on the strategy.
Some physicians may be comfortable with admitting that they do not know everything about a subject, but are willing to review the information outside of the appointment time and schedule follow-up appointments to discuss it Ahmad et al.
Other physicians may respond more negatively; physicians may react to a perceived threat to their authority by discrediting the knowledge and abilities of patients in an attempt to reestablish their positions of dominance in the relationships Broom, a; Broom, b.
Still others may attempt to rid themselves of the patients by sending them to specialists to deal with the information or by charging them for the additional time it takes to review the information Ahmad et al. Although physicians are still acknowledged by many people to be their primary sources of health information Kivits,the Internet is removing from physicians their exclusive control in this area; where patients once had to rely on physicians for medical information, they no longer have to do so Akerkar and Bichile, ; Broom, b; McMullan, The boundaries that have existed between physicians and patients in terms of expertise are increasingly being dissolved as health information becomes more widely available Hardey, Although technical medical training remains the domain of physicians, the realm of information has been opened to all.
This widespread availability of health information on the Internet is thus changing the dynamics of the physician-patient relationship in the direction of more patient-centred care Kaba and Sooriakumaran, in press. Information can enable patients to take more active roles in their health care, becoming more involved in making decisions about their health and in questioning the decisions made by physicians Anderson et al.
Patients often have both the time and the desire to become specialists in their own conditions, while many physicians frequently do not have this luxury Alper, 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.Dr. Vinay Kamat: The Importance of A Good Doctor-Patient Relationship
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.
Doctor patient relationship: changing dynamics in the information age.
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.
At the same time, we are witnessing efficient approaches in terms of costs and new solutions based on ICT. In many Western countries, the health industry sector is large Salles, Meanwhile, in Europe EU intotal health expenditures rose to 7.
However, many factors are contributing to this increase in expenditure on health matters. The main factor is a combined effect of a predictable increase in the aging population along with a tendency for per capita expenditures on health to increase with age Hummel, However, life expectancy increase and health care charges do not have a linear relationship as people not only require longer periods of treatment, but also frequency and intensity of health care increases.
According to Sallesthe intention to computerize and mechanize medicine was commendable: It would also permit faster and more accurate laboratory tests — especially those applying higher technology such as MRIs, CT scans, and genetic research, among other advances strictly connected to medical practice.