What does the “digital patient” expect from his or her physician? How can physicians respond to these expectations? Do people suffering illness really want to to determine their course of action with the help of digital media or is the oft-cited concept of “patient sovereignty” merely an abstraction that has emerged from the discourse on digitalization? The editorial staff at x.press, a magazine for office-based physicians in Germany, has taken our project name to heart and asked us what we think about the role of the patient in digital transformation. Below, we offer the full transcript of the interview. Our key takeaway:  Patients want to be treated well and have a say in their treatment. If there is a technology available that can help in this sense, they expect their physician to use it. And those who readily use digital forms of communication in other parts of their life do not want to have to go in person to the doctor’s office for everything.

x.press: What does “the digital patient” expect from his or her physician?

Was erwartet der digitale Patient von seinem Arzt? Einschätzungen zur Patientenrolle im digitalen Wandel“The” digital patient is just as illusory the idea of “the” patient. The simplest answer to that question is that all patients want to be treated well, and if the use of technology makes sense, the doctor is also expected to use it, or at least offer it. We see two basic trends: First, people’s communication habits are rapidly changing. If I use digital forms of communication in pretty much every other aspect of my life, I won’t want to have to go to the doctor’s office for every medical need. I’ll want to go only in cases where a personal consultation is really necessary. Secondly, patients with chronic conditions tend to be more confident and likely to exercise self-determination when it comes to their health. Technology offers a lot in supporting this approach. Health apps can be an effective tool in this regard.

x.press: If patients are so open to new forms of communication, why is there so much resistance to video consultations? Are the physicians at fault here?

No. Patients are basically in favor of things like video consultations, and the younger the patient, the more likely she or he is to favor it. Nevertheless, it will take a while for video-based communication to gain traction and be accepted as normal. Both physicians and patients alike must get used to it. We’re still in an early adoption phase here in Germany. Just look at what providers like Kaiser Permanente or companies such as Teladoc are doing in the United States, where digital physician – patient communication has become the standard. As is the case with every new technology, acceptance derives from experience and must be built in succession.

x.press: The concept of patient sovereignty has become near dogma in the digitization discourse in medicine. Does this idea meet the needs of the ill, or is it an empty abstraction?

I wouldn’t say that the idea of sovereignty in the sense of “autonomy” meets the needs of the ill. We need to differentiate in terms of the condition and the stage of a condition. Sovereignty can involve, for example, leaving decisions to your physician in specific contexts. Many patients with chronic conditions have been exercising their sovereignty for several years and have intimate knowledge of their condition. Access to information through the internet or good health apps supports this trend. But it doesn’t mean that these patients want to make decisions on their own exclusively. They want to decide with their physician.

x.press: What does this mean for patient’s rights to data in electronic files?

This is an issue that we are currently taking a closer look at. Basically, patients should have sovereignty over their data. Patients must be able to view their data and be able to determine who else can view which data. We also believe, however, that we need to discuss the limits of patients’ capacity to delete cross-institutional files, for example, or how to ensure that the content of a file is handled responsibly. So far, there are no conclusive answers to these questions.

x-press: What approach should a physician take to digital tools in 2017?

I would first recommend actively tackling the issue and seeking out exchange with other physicians who have more experience with digital tools. For example, we see that health information on the internet does not have to an “annoying” issue – it can, in fact, be used for positive impact. Good online information can help a patient prepare for an appointment at the doctor’s office and help them with post-appointment issues, which ultimately has benefits for the physician as well. This presupposes, however, that the physician is familiar with the information market for at least some indications and can make specific recommendations. Going forward, the interoperability of apps and technology will become more and more important. How well does my IT infrastructure interact with the tools used by my patients? In addition, it’s advisable that physicians develop a certain knowledge of the compensation situation. A growing number of digital medical tools are available within the framework of a selective contract and only a few that are available across-the-board. These can be actively recommended to patients.

x.press online issue 17.4 (in German)

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