Health Professionals' Education in the Age of Clinical Information Systems, Mobile Computing and Social Networks

Aviv Shachak,Elizabeth Borycki,Shmuel P. Reis

• Publisher: Academic Press
• Year: 2017
• ISBN:
  9780128093214
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Health Professionals' Education in the Age of Clinical Information Systems, Mobile Computing and Social Networks addresses the challenges posed by information and communication technology to health professionals' education, and the lessons learned from field experiences and research. This book is divided in three parts: "the changing landscape of information and communication technology in health care", in which it discusses how information and communication technology is transforming health care and the implications of these changes for health professions education; "experiences from the field", with real-life examples of health professionals' education in and for the digital era; and "evaluation of students and programs", addressing the use of technology to assess learners as well as the complexity of evaluating programs to enhance competence in an information technology-rich health care world

Written by leading researchers from different parts of the world, the book is a valuable source for educators and professionals who are active or wish to be part of the health informatics field.

• Brings an in-depth understanding and background on the challenges for education of the health professions brought by information and communication technology
• Provides real-life examples on how technology is used in healthcare and how it can be used in education
• Presents valuable information in a visually appealing format with tables and figures

Part I

The Changing Landscape of Information and Communication Technology (ICT) in Health Care: Implications for Health Professionals’ Education

Outline

Section I The Changing Nature of the Patient-Clinician Relationships

Section II Ethical and Professional Conduct in the Digital Age

Section III Patient Safety and Quality Assurance Thrusts in Digital Healthcare and their Influence on Clinicians and Patients

Section IV Health Information Literacy and Credibility Assessment

Section I

The Changing Nature of the Patient-Clinician Relationships

Outline

Chapter 1 Computers, Patients, and Doctors—Theoretical and Practical Perspectives

Chapter 2 What’s All This Silence? Computer-Centered Communication in Patient-Doctor-Computer Communication

Chapter 3 Overcoming Health Disparities: The Need for Communication and Cultural Competency Training for Healthcare Providers Practicing Virtually in Rural Areas

Chapter 1

Computers, Patients, and Doctors—Theoretical and Practical Perspectives

Christopher Pearce, University of Melbourne, Parkville, VIC, Australia

Abstract

The core activity of medicine remains the interaction between humans although this is increasingly being challenged, or at least changed, by the revolution brought by the digitization of society. While other aspects of societal transactions (such as banking and law) can now be conducted almost entirely in an online environment, the practice of medicine still requires personal contact, both because it is done “to” the person and increasingly “with” the person. In parallel with this, development in health has come academic research to understand these changes at a deeper level. Such research has included both empirical analysis and theory development, described in this chapter.

Keywords

Patient–physician relationships; electronic medical records; social interactions; language; computers

Introduction

The core activity of medicine remains the interaction between humans, although this is increasingly being challenged, or at least changed, by the revolution brought by the digitization of society. Whilst other aspects of societal transactions (such as banking and law) can now be conducted almost entirely in an online environment, the practice of medicine still requires personal contact, both because it is done “to” the person and increasingly “with” the person. In parallel with this development in health has come academic research to understand these changes at a deeper level. Such research has included both empirical analysis and theory development.

Theory development is essential to academic understanding yet in this particular area, theory development has lagged behind empirical analysis [1]. The object of this chapter is to outline the conceptual development of this interaction, both as a dyadic (patient and doctor), and now a triadic environment (including the computer), and to relate these concepts to the implications for educating health professionals into the future. It shall include history, models, and theory, to better understand where the social practice of medicine has come from, and were therefore it might go into the future.

The rapid computerization of the world in general has changed many of the fundamentals of society. Computers—as characterized as the box that sits on a desktop, are now taking a conceptual back seat as the internet (itself nothing more than networked computers) and devices such as phones and tablets come to mediate our relationship with the digital world. Increasingly, it is about information, not technology. Human society has experienced such changes in modernization before—the age of enlightenment, the industrial revolution, and each has been associated with upheaval as society adjusts to new ways of doing things and new ways of thinking. In each case, the practice of healthcare has made adjustments to integrate these new ways of thinking, but in each case, it has maintained the human interaction at its core.

In many ways, the largest most recent challenge to this human interaction has been the introduction of the scientific method in the latter part of the 19th century. The concept of the “body as a machine” has permeated much of medical science in the last century. The understanding of the “body as a machine” and the promise of truly effective cures, led to a belief that medicine no longer needed to worry about the “nonmechanical” parts of the human, that a pill would fix all things. Because of this, over the last century science has in many ways attempted to remove the doctor–patient relationship from our political and social structures [2]. As a result, modern medicine is an extraordinary work of reason: an elaborate system of specialized knowledge, technical procedures, and rules of behavior. However, by no means is medicine purely a rational process; our conceptions of disease and responses to it unquestionably show the imprint of our culture.

Whilst any interaction between humans can be characterized as a social interaction, what is unique about this relationship? The relationship even has a specific name, “the consultation,” a name based on one of its key features being that it is (usually) initiated by the patient, who “consults” the doctor as to how their problem can be addressed [3]. The common thread throughout the doctor–patient relationship is the presence of, or more correctly a concern about the presence of, disease. And it is this concern, this oft unspoken presence, which underpins the whole relationship. The concern about disease has different meanings for the participants of the relationship. Diseases can have different natures according to the perspective of the participants [4]. The patient can see it as a threat or a burden to their life, or a source of fear, while the doctor may approach it more as a riddle, to be organized and classified in order to be understood; an intellectual puzzle. So disease may not necessarily imply a physical problem, but has been more correctly described as disease, or the presence of a disturbance in the perception of the patient [5]. We will see later how computers are now involved in this process of translation. Indeed, it is the computer’s role in information flow that is central to its involvement.

History and Models

The relationship between physicians and their patient has long been recognized as being of central importance to the practice of medicine [6]. In 1991, the Toronto Consensus Statement on Doctor-Patient Communication [7] was created in response to the recognition that roughly 50% of patient complaints and concerns are often not identified in the consultation [8], and that trainees [9] and practicing physicians [10] often have significant deficiencies in effective communication skills toward their patients. Seven principles have been described that underpin good doctor–patient communication [11]; that it should:

• serve the patient’s need to tell the story of his or her illness, and the doctor’s need to hear it;

• reflect the special expertise and insight that the patient has into his or her physical state and well-being;

• reflect and respect the relationship between a patient’s mental state and his or her physical experience of illness;

• maximize the usefulness of physicians’ expertise;

• acknowledge and attend to its emotional content;

• openly reflect the principle of reciprocity of the standing of those involved—doctors and patients; and

• help participants overcome stereotyped roles and expectations so that both participants gain a sense of power and freedom to change.

Michael Balint, an English psychiatrist in the 1950s, was one of the first to examine the patient–doctor relationship in detail. He worked with large numbers of inner London general practitioners to identify some of the details of the relationship in a groundbreaking study. He presented the results of this work in his book The Doctor. His Patient and the Illness [12]. In his introduction, he says:

The first topic chosen for discussion at one of these seminars happened to be the drugs usually prescribed by practitioners. The discussion quickly revealed…that by far the most frequently used drug in general practice was the doctor himself, i.e. that it was not only the bottle of medicine or the box of pills that mattered, but the way the doctor gave them to his patient – in fact the whole atmosphere in which the drug was given and taken. (12: 1)

Balint’s description above was the first time that anyone had specifically identified the doctor as an important, independent part of the relationship. Nevertheless, his view took a very doctor-centric approach, and in many ways followed the doctor-dominant paradigm of the time in which doctors did things to patients; whether they used themselves, or drugs, or other procedures. Whilst Balint was emphasizing the role of the doctor, others were attempting to emphasis the relational aspects of the interaction, by describing it as “an abstraction embodying the activities of two interacting people” [13], thereby suggesting that the consultation was in some way different to just a simple interaction, that it was in some way unique.

Stott and Davis [14] highlighted the potential positive effect that could be generated by each primary care consultation. They outlined how each interaction had the potential to manage both the presenting and potential problems, provided the opportunity for health promotion activities and the modification of help-seeking behavior. This was modified [15] to identify how in each consultation there exists a patient and a doctor agenda, which must then merge into a negotiated plan or outcome from the consultation.

George Engels, an American psychiatrist, described the failings of the biomedical model, and suggested a broader approach that included both psychological and social issues. Not surprisingly, this method was called the “biopsychosocial” model [16]. The outcome of this concept was to shift the focus from diseases doing something to a person, to illnesses as something being experienced by a person. Development of this model of patient-centered method continued, with many interpretations of this term. Moira Stewart and colleagues [17] have provided the most comprehensive definition of Patient Centered Clinical Method (PCCM), with six key components:

1. Exploring both the disease and the illness experience.

2. Understanding the whole person.

3. Finding common ground.

4. Incorporating prevention and health promotion.

5. Enhancing the doctor–patient relationship.

6. Being realistic.

Whilst PCCM is a practical approach, others have been continuing the theory development, describing different models of the relationship [13]. Emanuel and Emanuel [18] followed the notion of ideal types [19], and constructed a typology for the doctor–patient relationship. An ideal type is formed from characteristics and elements of the given phenomena, but it is not meant to correspond to all of the characteristics of any one particular case. It is designed to stress certain elements common to most cases of the given phenomenon. From this work, we can generate four ideal types of the relationship:

• Paternalistic: also called the parental or priestly model. In this model, the doctor acts as the patient’s guardian, articulating and implementing what they feel is in the patient’s best interest.

• Informative: also called the scientific, engineering or consumer model. The obligation here is for the doctor to provide all the available facts, and then the patient, with their own value set, determines the outcome.

• Interpretive: here the aim is for the doctor to elucidate the patients’ value system, and thereby help select the best intervention.

• Deliberative: In this final model, the doctor acts as teacher or friend.

These models can then be expanded: including the further elements of patient values, doctor’s obligations, patient autonomy, ...