The End of the Golden Age of Doctoring and eHealth

McKinlay and Marceau wrote The end of the golden age of doctoring. In this article the authors discussed eight interrelated reasons for the decline of the golden age of doctoring:

Major extrinsicfactors (generally outside the control of the profession) include:

• (1) the changing nature of the state and loss of its partisan support for doctoring,
• (2) the bureaucratization (corporatization) of doctoring;
• (3) the emerging competitive threat from other health care workers;
• (4) the consequences of globalization and the information revolution;
• (5) the epidemiologic transition and changes in the public conception of the body; and
• (6) changes in the doctor-patient relationship and the erosion of patient trust

Major intrinsic factors are:

• (7) the weakening of physicians’ labor market position through oversupply; and
• (8) the fragmentation or weakening of the physicians, union (AMA).

Point (4) is related to the informations revolution. Most of the researches about information and communication technologies in healthcare are paying attention to the relationship among patients and healthcare professionals or to the economic consequences of ICT. But as the authors suggests more attention should be paid to the interactions between people (professionals and citizens) and healthcare providers.

Eysenbach has defined the meaning of “e” in e-health as:

• 1. Efficiency – one of the promises of e-health is to increase efficiency in health care, thereby decreasing costs. One possible way of decreasing costs would be by avoiding duplicative or unnecessary diagnostic or therapeutic interventions, through enhanced communication possibilities between health care establishments, and through patient involvement.
• 2. Enhancing quality of care – increasing efficiency involves not only reducing costs, but at the same time improving quality. E-health may enhance the quality of health care for example by allowing comparisons between different providers, involving consumers as additional power for quality assurance, and directing patient streams to the best quality providers.
• 3. Evidence based – e-health interventions should be evidence-based in a sense that their effectiveness and efficiency should not be assumed but proven by rigorous scientific evaluation. Much work still has to be done in this area.
• 4. Empowerment of consumers and patients – by making the knowledge bases of medicine and personal electronic records accessible to consumers over the Internet, e-health opens new avenues for patient-centered medicine, and enables evidence-based patient choice.
• 5. Encouragement of a new relationship between the patient and health professional, towards a true partnership, where decisions are made in a shared manner.
• 6. Education of physicians through online sources (continuing medical education) and consumers (health education, tailored preventive information for consumers)
• 7. Enabling information exchange and communication in a standardized way between health care establishments.
• 8. Extending the scope of health care beyond its conventional boundaries. This is meant in both a geographical sense as well as in a conceptual sense. e-health enables consumers to easily obtain health services online from global providers. These services can range from simple advice to more complex interventions or products such a pharmaceuticals.
• 9. Ethics – e-health involves new forms of patient-physician interaction and poses new challenges and threats to ethical issues such as online professional practice, informed consent, privacy and equity issues.
• 10. Equity – to make health care more equitable is one of the promises of e-health, but at the same time there is a considerable threat that e-health may deepen the gap between the “haves” and “have-nots”. People, who do not have the money, skills, and access to computers and networks, cannot use computers effectively. As a result, these patient populations (which would actually benefit the most from health information) are those who are the least likely to benefit from advances in information technology, unless political measures ensure equitable access for all. The digital divide currently runs between rural vs. urban populations, rich vs. poor, young vs. old, male vs. female people, and between neglected/rare vs. common diseases.

The introduction and use of ICT in healthcare could reach those “e” but always taking into account the interests and values of healthcare professionals. The change will be easier if the organizations introduce the technology with (and not against) the professionals, who are probably more afraid about organization’s power than to the patients’ empowerment.

The conflicts couldn’t be avoided but could be managed taking into account all the actors who are involved in the information revolution.