Turning the gaze: Digital patient feedback and the silent pathology of the NHS

Abstract

Online review and rating sites, where patients can leave feedback on their experience of the health‐care encounter, are becoming an increasing feature of primary care in the NHS. Previous research has analysed how digital surveillance is re‐shaping the clinical gaze, as health‐care professionals are subject to increased public monitoring. Here, we draw on an empirical study of 41 GP practice staff to show how the gaze is turning, not simply from the patient to the health‐care provider, but additionally to the body politic of the NHS. Drawing on focus group and interview data conducted in five UK practices, we show how discourses of online reviews and ratings are producing new professional subjectivities among health‐care professionals and the extent to which the gaze extends not only to individual health‐care interactions but to the health‐care service writ large. We identify three counter‐discourses characterising the evolving ways in which online reviews and ratings are creating new subjects in primary care practices: victimhood, prosumption versus traditional values and taking control. We show how the ways in which staff speak about online feedback are patterned by the social environment in which they work and the constraints of the NHS they encounter on a day‐to‐day basis.

A glimpse behind the organisational curtain: A dramaturgical analysis exploring the ways healthcare staff engage with online patient feedback ‘front’ and ‘backstage’ at three hospital Trusts in England

“…Importantly, responding conversationally was not something that staff felt able to enact independently, demonstrating how this was unfamiliar and uncomfortable territory. Much work within the wider context of healthcare was supported by formalised policy and procedure, and could be conducted privately or in the comfort of a small identifiable audience, whereas the public domain extended ‘gaze’ (Montgomery et al., 2022). For that reason, individual preformative trajectories were often predetermined by prescribed ‘scripts’.…”

“…Montgomery et al. (2022) described how the digital reach of online patient feedback may extend ‘gaze’ beyond isolated patient‐healthcare interactions in primary care. Rather, staff perceive that gaze transcended to a public forum, encompassing much more of the healthcare service in its entirety, having the potential to disrupt power relations.…”

“…This may result in staff not only feeling pressure to collect, hear and learn from patient feedback, but also to do so promptly, transparently and personably (Powell et al, 2019). Montgomery et al (2022) described how the digital reach of online patient feedback may extend 'gaze' beyond isolated patient-healthcare interactions in primary care. Rather, staff perceive that gaze transcended to a public forum, encompassing much more of the healthcare service in its entirety, having the potential to disrupt power relations.…”

Drug Quality Supervision Strategy Analysis under Government Rewards and Punishments: What Role does Patient Feedback Play？

“…2022) [26]. Patient feedback can better play the role of the co-governance information platform (Emmert M, et al 2021[27]; Montgomery C M, et al 2021 [28]), constrain the behavior of pharmaceutical enterprises and retailers, effectively improve the supervision efficiency of government, and ensure drug quality and safety (Lopes M R, et al 2020) [29].…”

‘When the visible body is no longer the seer’: The phenomenology of perception and the clinical gaze in video consultations

“…Foucault’s (2003) concept of the clinical gaze refers to the way in which medical knowledge and practice is produced by power relations, as doctors ‘read’ the body and restructure the perception of illness (Armstrong, 1984). Work that draws on Foucauldian concepts to analyse how remote consultations change what is seen and known situates remote interactions as troubling the clinical gaze and disrupting power structures, for example, through patients’ online feedback (Montgomery et al., 2021, p. 15). Further analyses describe the objectifying gaze of the virtual body in physiological examinations (Maseide, 2011) and how the clinical gaze is complimented and transformed by imaging technology (Ristic et al., 2021).…”