Recent Publication: Why do They Need to Check me?” eHealth as Power Struggle in the Doctor-Patient Relationship

Physicians have a very stressful situation and many of them risk stress symptoms due to working too hard. The situation in health care is indeed alarming, and the numerous new IT systems introduced and changing health care are not always well received. One doctor I met asked:

What is the problem they are trying to solve with these new systems, the only thing they do is to create new problems!!

There is also research studies describing this situation such as as Sofie Wass and Vivian Vimarlunds publication named: I got 99 problems and eHealth is one which signals the same thing as the above quote.

When patient accessible electronic health records was launched into the lives of physicians many of them strongly disliked the idea. Some of them even thought of the system as a threat to their profession, and thought that the system was there to monitor physicians and the mistakes they make. Like the cat in the picture who sneaks and peaks on something patients would use patient electronic health records to sneak on physicians and control them as in the question in the title of the paper “Why do they need to check me?”.  There was indeed a very long list of things physicians worried about, and in this publication we dig into and explore some of their perspective on the system. The abstract is coped below, and the full publication can be found here.  The paper is written together with the excellent Christiane Grünloh, Gunilla Myreteg and Hanife Rexhepi.


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.