How does the use of digital consulting change the meaning of being a patient and/or a health professional? Lessons from the Long-term Conditions Young People Networked Communication study

Abstract

Background While studies have examined the impact of digital communication technology on healthcare, there is little exploration of how new models of digital care change the roles and identities of the health professional and patient. The purpose of the current study is to generate multidisciplinary reflections and questions around the use of digital consulting and the way it changes the meaning of being a patient and/or a health professional. Method We used a large pre-existing qualitative dataset from the Long-term Conditions Young People Networked Communication (LYNC) study which involved interviews with healthcare professionals and a group of 16–24 years patients with long-term physical and mental health conditions. We conducted a three-stage mixed methods analysis. First, using a small sample of interview data from the LYNC study, we identified three key themes to explore in the data and relevant academic literature. Second, in small groups we conducted secondary analysis of samples of patient and health professional LYNC interview data. Third, we ran a series of rapid evidence reviews. Findings We identified three key themes: workload/flow, impact of increased access to healthcare and vulnerabilities. Both health professionals and patients were 'on duty' in their role more often. Increased access to healthcare introduced more responsibilities to both patients and health professionals. Traditional concepts in medical ethics, confidentiality, empathy, empowerment/power, efficiency and mutual responsibilities are reframed in the context of digital consulting. Conclusions Our collaboration identified conflicts and constraints in the construction of digital patients and digital clinicians. There is evidence that digital technologies change the nature of a medical consultation and with it the identities and the roles of clinicians and patients which, in turn, calls for a redefinition of traditional concepts of medical ethics. Overall, digital consulting has the potential to significantly reduce costs while maintaining or improving patient care and clinical outcomes. Timely study of digital engagement in the National Health Service is a matter of critical importance.

“Therefore, I would like an allergy test”

“…Furthermore, as we showed in the analysis, the platform helps to shape what are considered consultations; in the analysis of the mode of affi rming one's own role in healthcare, the patient John initiated a conversation with his GP merely to state that he had studied a particular medication and found that the information was harsh. Consequently, as argued elsewhere (Sturt et al, 2020), using channels of communication other than face-to-face communication for consultations can change how consultations are played out. John thereby has a new way of affi rming his role in healthcare, and the platform provides him with a new opportunity to be an active and responsible biological citizen.…”

Towards Mapping of Information Technology-Induced Alterations in Online Physicians’ Professional Identities: A Conceptual Framework and Empirical Illustrations from Sweden

“…The technological means for enabling digital contact with patients have been of foremost interest to practitioners and researchers in recent years [2], [3]. The pivotal role of these solutions was further strengthened by the COVID-19 pandemic crisis [4].…”

“…Speculatively, a number of aspects of the existing medical work will get significantly impacted, given the role that DPCT is to play in medicine in the near future [1], [11]. Overall, it becomes clear that " [t]raditional concepts in medical ethics, confidentiality, empathy, empowerment/power, efficiency and mutual responsibilities are reframed in the context of digital consulting" [4] or DPCT. One common point of criticism is the negative impact of DPCT on the patient-physician relationship [12], [13].…”

“…One common point of criticism is the negative impact of DPCT on the patient-physician relationship [12], [13]. Another essential factor to consider is the possible change in job content and work routines [4], responsibilities and decision-making strategies [3], and the identities of healthcare professionals [14]. The latter aspect is the primary concern of the present work.…”

Adult patients’ experiences of patient-professional communication in patient portals: a qualitative systematic review protocol

“…4 Telemedicine services are often provided alongside face-to-face communication. They can be considered complementary to face-to-face health care services because this new form of care can improve patients' access to care, 5 patient engagement, and adherence to treatment. 6 A few examples of telemedicine services are video and phone consultations, emails, text messages, and patient portals.…”