The Antecedents of Poor Doctor-Patient Relationship in Mobile Consultation: A Perspective from Computer-Mediated Communication

Theoretical Perspectives Underpinning Research on the Physician-Patient Relationship in a Digital Health Practice: Scoping Review

BACKGROUND

The advent of digital health technologies has transformed the landscape of health care, influencing the dynamics of the physician-patient relationship. Although these technologies offer potential benefits, they also introduce challenges and complexities that require ethical consideration.

OBJECTIVE

This scoping review aims to investigate the effects of digital health technologies, such as digital messaging, telemedicine, and electronic health records, on the physician-patient relationship. To understand the complex consequences of these tools within health care, it contrasts the findings of studies that use various theoretical frameworks and concepts with studies grounded in relational ethics.

METHODS

Using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, we conducted a scoping review. Data were retrieved through keyword searches on MEDLINE/PubMed, Embase, IEEE Xplore, and Cochrane. We screened 427 original peer-reviewed research papers published in English-language journals between 2010 and 2021. A total of 73 papers were assessed for eligibility, and 10 of these were included in the review. The data were summarized through a narrative synthesis of the findings.

RESULTS

Digital health technologies enhance communication, improve health care delivery efficiency, and empower patients, leading to shifts in power dynamics in the physician-patient relationship. They also potentially reinforce inequities in health care access due to variations in technology literacy among patients and lead to decreases in patient satisfaction due to the impersonal nature of digital interactions. Studies applying a relational ethics framework have revealed the nuanced impacts of digital health technologies on the physician-patient relationship, highlighting shifts toward more collaborative and reciprocal care. These studies have also explored transitions from traditional hierarchical relationships to mutual engagement, capturing the complexities of power dynamics and vulnerabilities. Other theoretical frameworks, such as patient-centered care, and concepts, such as patient empowerment, were also valuable for understanding these interactions in the context of digital health.

CONCLUSIONS

The shift from hierarchical to collaborative models in the physician-patient relationship not only underscores the empowering potential of digital tools but also presents new challenges and reinforces existing ones. Along with applications for various theoretical frameworks and concepts, this review highlights the unique comprehensiveness of a relational ethics perspective, which could provide a more nuanced understanding of trust, empathy, and power dynamics in the context of digital health. The adoption of relational ethics in empirical research may offer richer insights into the real-life complexities of the physician-patient relationship, as mediated by digital technologies.

Therapeutic Relational Connection in Telehealth: Concept Analysis

BACKGROUND

Therapeutic relational connection (TRC) in telehealth is a new concept that refers to the intentional use of relationship connection between health care providers and their patients as both parties work toward a therapeutic aim. It has been demonstrated that TRC positively affects patient-centered outcomes including adherence, self-management, and satisfaction with care. What is not known are best practices for establishing TRC during telehealth visits. The rapid emergence of telehealth during the COVID-19 pandemic has identified a number of challenges. These challenges include lack of human contact, distance creating mistrust, the inability to rely on nonverbal communication, and a sense of depersonalization. Training for health care providers in these interpersonal communication skills needed to establish TRC during telehealth visits is needed.

OBJECTIVE

This paper aims to explore the evolutionary concept of TRC in telehealth. The purpose of this paper is to provide a concept analysis of TRC during telehealth interactions between providers and patients through a comprehensive review of the existing published literature.

METHODS

Rodgers' evolutionary concept analysis method was used to guide this study. PubMed, Embase, PsycINFO, and CINAHL were used to search for relevant publications. An integrative review strategy aided by Rayyan software was used to identify a final sample of 13 papers for analysis.

RESULTS

The proposed definition of TRC in telehealth is the experience of a mutually responsive patient-provider relationship that is built on mutual respect and understanding and informed by cultural humility, presence, empathy, and the ability to effectively evaluate patient concerns to work toward a therapeutic aim. The key attributes of TRC in telehealth are the provider's ability to evaluate patient concerns, interpersonal communication, cultural humility, mutual trust and respect, presence, empathy, and building relationships. Clinical presence, proper environment, knowledge about the use of technology (both patient and provider), use of verbal and nonverbal communication, and knowledge about community and culture are important antecedents of TRC. Consequences of TRC include improved communication resulting in mutual respect and caring, adherence to follow-up recommendations, increased coping, collaborative decision-making, and satisfaction with care.

CONCLUSIONS

Telehealth visits necessitate alternative approaches to establishing TRC as compared to in-person clinic visits. With the rapid expansion of telehealth platforms and a heightened acceptance of the technology, there is a need to integrate knowledge and provide a clear conceptualization of TRC in telehealth as TRC has been demonstrated to result in positive patient-centered outcomes. Identifying the attributes and antecedents of TRC in telehealth allows us the opportunity to develop guidelines and educational interventions aimed at training health care providers in the skills needed to establish TRC during telehealth visits.

Physicians' Online Writing Language Style and Patient Satisfaction: The Mediator of Depth of Physician-Patient Interactions

Online health counseling (OHC) is increasingly important in modern healthcare. This development has attracted considerable attention from researchers. However, the reality of the lack of physician-patient communication and dissatisfaction with online health services remains prevalent, and more research is needed to raise awareness about important issues related to OHC services, especially in terms of patient satisfaction and depth of interaction (i.e., the product of the number of interactions and the relevance of the content). This study constructs an empirical model to explore the relationship between physicians' online writing language style (inclusive language and emojis), depth of physician-patient interactions, and patient satisfaction. The study obtained 5064 online health counseling records from 337 pediatricians and analyzed them using text mining and empirical methods. The results showed that physicians' inclusive language (β = 0.3198, p < 0.05) and emojis (β = 0.6059, p < 0.01) had a positive impact on patient satisfaction. In addition, the depth of the physician-patient interaction partially mediated this effect. This study promotes a better understanding of the mechanisms of physician-patient interactions in online settings and has important implications for how online physicians and platforms can better provide online healthcare services.

Increasing clinical medical service satisfaction: An investigation into the impacts of Physicians' use of clinical decision-making support AI on patients' service satisfaction

BACKGROUND

The medical industry is one of the key industries for the application of artificial intelligence (AI). Although it is believed that the combination of CDSS and physicians could improve the medical service, there are still many concerns about the usage of CDSS. Based on these concerns, limited studies have answered the question that when a physician makes decision independently or with AI's help, will there be any differences in patients' satisfaction with the medical service?

METHODS

This study uses the service fairness theory as a theoretical lens and employs three vignette experiments to address this research gap. There are totally 740 subjects recruited to participate into the three experiments. Group comparison methods and structural equation model are used to verify the hypotheses.

RESULTS

The experimental results reveal that: (1) physicians using AI can reduce patients' service satisfaction (M_difference=0.404,p=0.004); (2) the negative relationship between AI usage and service satisfaction can partially be mediated through distributive fairness and procedural fairness; (3) physicians actively informing their patients about the usage of AI can help mitigate the reduction in service satisfaction (M_difference=0.400,p=0.003) and three types of fairness M_difference^distributive=0.307,p=0.042;M_difference^procedural=0.483,p<0.001;M_difference^{interactional}=0.253,p=0.027.

CONCLUSION

This study investigates the effect of physicians using decision-making support AI on their patients' service satisfaction. These results contribute to the existing literature pertaining to AI and fairness theory, and also help in formulating some practical suggestions for medical staff and AI development companies.

Repetitions in online doctor-patient communication: Frequency, functions, and reasons

OBJECTIVES

To attain insights into language repetition during online doctor-patient communication (DPC), understand why doctors and patients use repetition, and improve the current deficiencies in online medical platforms.

METHODS

The study performed a content analysis of 72 sets of textual doctor-patient conversations on the Chinese online medical consultation platform Chunyu Doctor.

RESULTS

Repetitions occurred 1412 times in the 72 sets of online DPC. Patient self-repetitions were the most prevalent (30.7 %), while patient repetitions of doctors were the least common (17.1 %). Doctors used repetitions for explanations and affirmations. Patients used repetition for emphasis, verification, and turn-taking. The repetition frequencies of doctors and patients were primarily influenced by personal factors. However, doctor-dimension factors exerted a greater impact on the frequency of patient repetitions.

CONCLUSIONS

The reasons for repetitions in online DPC differ from those offline. Online DPC increases patient initiative and reduces doctor authority. Nevertheless, it could be affected by gender stereotypes generated during offline consultations. Doctors still dominated the conversations but attended sufficiently to the patient discourse. Online DPC is gradually attempting to fulfill the expectations of a new patient-centered healthcare pattern.

PRACTICAL IMPLICATIONS

The findings yield suggestions for healthcare providers and the designers of online healthcare platforms.

Drug closed-loop management system using mobile technology

BACKGROUND

Drug closed-loop management reflects the level of hospital management and pharmacist service. It is a challenge for hospital pharmacists to realize the whole-process closed-loop management of drugs in hospital pharmacies. Therefore, this study aimed to evaluate the operational effect of using mobile technology to build a closed-loop drug management system.

METHODS

Using mobile technology, replacing the traditional paper dispensing model and constructing a multinode information collection system according to the Healthcare Information and Management Systems Society Standard, we reformed the hospital information system and inpatient pharmacy workflow and then evaluated the new approach using statistical methods.

RESULTS

After the transformation, the entire process of drug data can be traced. Closed-loop management, as well as real-time data verification and control, thereby improves the work efficiency and reduces the drug dispensing time. By reducing the work error rate, the number of dispensing errors decreased from 5 to 1 case/month. The comprehensive dispensing process can achieve the whole workflow of paperless operation and reduce the use of paper A4 by 180,000 pieces per year.

CONCLUSIONS

Mobile technology can improve the service level of pharmacies, enhance the level of drug management and hospital quality management, ensure the safety of medication for inpatients, and significantly reduce the amount of paper used.

How to Maintain a Sustainable Doctor-Patient Relationship in Healthcare in China: A Structural Equation Modeling Approach

It is important to identify means of improving and maintaining a sustainable doctor-patient relationship to address current healthcare issues. Although many studies have made outstanding contributions to the healthcare doctor-patient relationship literature, little work has been done to explore the influencing elements of the doctor-patient relationship in relation to expectation confirmation theory. To fill this gap, this study produced a theoretical framework model of the influencing factors of the doctor-patient relationship according to the expectation confirmation theory. Data from 335 Chinese patients were analyzed using a structural equation modeling method, and the results showed that patient satisfaction and patient trust are the most important factors in building a good relationship between doctor and patient. Furthermore, three components of postdiagnosis patient's perception, namely, perceived service quality, perceived communication quality, and perceived service attitude, are examined. These have a significant impact on patient confirmation. These three components ultimately affect the doctor-patient relationship. This study will be helpful for doctors to understand patients' service demands and their future diagnosis behavior. The proposals of this study may lead to optimization of the process of diagnosis and improvements in the quality of clinic services.

Telemonitoring in Long-COVID Patients-Preliminary Findings

The COVID-19 pandemic has revealed the high usefulness of telemedicine. To date, no uniform recommendations or diagnostic protocols for long-COVID patients have been developed. This article presents the preliminary results of the examination of patients after SARS-CoV-2 infection who were provided with medical telemonitoring devices in order to oversee their pulmonological and cardiological health. Three cases have been analyzed. Each patient underwent a 10-day registration of basic vital signs, in three 15-min sessions daily: RR (respiratory rate), ECG (electrocardiogram), HR (pulse), SPO₂ (saturation), body temperature and cough. Rule methods and machine learning were employed to automatically detect events. As a result, serious disorders of all the three patients were detected: cardiological and respiratory disorders that required extended diagnostics. Furthermore, average values of the selected parameters (RR, HR, SPO₂) were calculated for every patient, including an indication of how often they exceeded the alarm thresholds. In conclusion, monitoring parameters in patients using telemedicine, especially in a time of limited access to the healthcare system, is a valuable clinical instrument. It enables medical professionals to recognize conditions which may endanger a patient’s health or life. Telemedicine provides a reliable assessment of a patient’s health status made over a distance, which can alleviate a patient’s stress caused by long-COVID syndrome. Telemedicine allows identification of disorders and performing further diagnosis, which is possible owing to the implementation of advanced analysis. Telemedicine, however, requires flexibility and the engagement of a multidisciplinary team, who will respond to patients’ problems on an ongoing basis.