"why do they need to check me?" patient participation through ehealth and the doctor-patient relationship : Qualitative study

• Background: Roles in the doctor-patient relationship are changing and patient participation in health care is increasingly emphasized. Electronic health (eHealth) services such as patient accessible electronic health records (PAEHRs) have been implemented to support patient participation. Little is known about practical use of PAEHR and its effect on roles of doctors and patients. Objective: This qualitative study aimed to investigate how physicians view the idea of patient participation, in particular in relation to the PAEHR system. Hereby, the paper aims to contribute to a deeper understanding of physicians' constructions of PAEHR, roles in the doctor-patient relationship, and levels and limits of involvement. Methods: A total of 12 semistructured interviews were conducted with physicians in different fields. Interviews were transcribed, translated, and a theoretically informed thematic analysis was performed. Results: Two important aspects were identified that are related to the doctor-patient relationship: roles and involvement. The physicians viewed their role as being the ones to take on the responsibility, determining treatment options, and to be someone who should be trusted. In relation to the patient's role, lack of skills (technical or regarding medical jargon), motives to read, and patients' characteristics were aspects identified in the interviews. Patients were often referred to as static entities disregarding their potential to develop skills and knowledge over time. Involvement captures aspects that support or hinder patients to take an active role in their care. Conclusions: Literature of at least two decades suggests an overall agreement that the paternalistic approach in health care is inappropriate, and a collaborative process with patients should be adopted. Although the physicians in this study stated that they, in principle, were in favor of patient participation, the analysis found little support in their descriptions of their daily practice that participation is actualized. As seen from the results, paternalistic practices are still present, even if professionals might not be aware of this. This can create a conflict between patients who strive to become more informed and their questions being interpreted as signs of critique and mistrust toward the physician. We thus believe that the full potential of PAEHRs is not reached yet and argue that the concept of patient empowerment is problematic as it triggers an interpretation of "power" in health care as a zero-sum, which is not helpful for the maintenance of the relationship between the actors. Patient involvement is often discussed merely in relation to decision making; however, this study emphasizes the need to include also sensemaking and learning activities. This would provide an alternative understanding of patients asking questions, not in terms of "monitoring the doctor" but to make sense of the situation.

Ämnesord

SAMHÄLLSVETENSKAP  -- Medie- och kommunikationsvetenskap -- Systemvetenskap, informationssystem och informatik med samhällsvetenskaplig inriktning (hsv//swe)

SOCIAL SCIENCES  -- Media and Communications -- Information Systems, Social aspects (hsv//eng)

SAMHÄLLSVETENSKAP  -- Medie- och kommunikationsvetenskap -- Mänsklig interaktion med IKT (hsv//swe)

SOCIAL SCIENCES  -- Media and Communications -- Human Aspects of ICT (hsv//eng)

NATURVETENSKAP  -- Data- och informationsvetenskap -- Systemvetenskap, informationssystem och informatik (hsv//swe)

NATURAL SCIENCES  -- Computer and Information Sciences -- Information Systems (hsv//eng)

NATURVETENSKAP  -- Data- och informationsvetenskap -- Datavetenskap (hsv//swe)

NATURAL SCIENCES  -- Computer and Information Sciences -- Computer Sciences (hsv//eng)

TEKNIK OCH TEKNOLOGIER  -- Elektroteknik och elektronik -- Datorsystem (hsv//swe)

ENGINEERING AND TECHNOLOGY  -- Electrical Engineering, Electronic Engineering, Information Engineering -- Computer Systems (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskap -- Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Health Sciences -- Health Care Service and Management, Health Policy and Services and Health Economy (hsv//eng)

NATURVETENSKAP  -- Data- och informationsvetenskap -- Människa-datorinteraktion (hsv//swe)

NATURAL SCIENCES  -- Computer and Information Sciences -- Human Computer Interaction (hsv//eng)

Nyckelord

Doctor-Patient Relationship

Ehealth Services For Patients

Medical Records

Patient Accessible Electronic Health Records

Patient Empowerment

Patient Participation

Patient Portal

Personal Health Records

Physicians

adult

article

decision making

electronic health record

electronic patient record

empowerment

genetic transcription

human

learning

monitoring

qualitative research

responsibility

semi structured interview

skill

telehealth

thematic analysis

Informationssystem (IS)

Information Systems

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)