The Impact of the Internet on Healthcare
Introduction
The
Internet, a wireless web of computer networks, could be considered a tool
that is still in its infancy as access to the World Wide Web only became
widespread in 1998 in the United States (United Nations Report 1999).Internet
users were expected to exceed 700 million by the year 2001 (United Nations
Report 1999).Despite the newness
of the Internet, it is becoming a dominant force in our lives.We
can use the Internet to check out library books, to order groceries, to
contact Aunt Martha in New Zealand, and to look for information on the
new drug prescribed by our doctor.It
is believed that these empowered consumers will dramatically change the
health-care industry.Consumers
in 2010 are expected to demand more from their health care providers quick
and will frequently turn to the Internet to determine their needs and search
out more appropriate sources of services and information (Lach 2000).
There
are four main issues that have surfaced in the research on the influence
of the Internet upon health care.First,
does the Internet actually empower health care consumers?Second,
does the advent of the Internet change the nature of the relationship between
doctors and patients?Third, does
the Internet change the relationships between doctors themselves and their
relationships with other health care providers?Finally,
how is the health care organization changing in response to the Internet
and computer technology?It is these
questions that are addressed in the current paper.Before
moving on to addressing these issues, there are two points of clarification
that need to be made.First, the
majority of the research focuses on the United States and the impact of
the Internet on its health care system.Second,
there is little data on the influence of the Internet upon health care,
and the majority of the information is speculative and theoretical in nature.Despite
these drawbacks, these issues are still important to consider.
Health Seeking Consumers
Some
statistics from 1998 place the number of health related Web sites at over
10,000, and it is likely that the number is even higher now (Goldschmidt
& Liao 1998).The vast quantity
of information on the Internet covering health related information makes
it difficult for consumers to distinguish between high quality information
and fraudulent cure-alls (Goldschmidt & Liao 1998).Furthermore,
the variety of information topics accessible on the Internet is astounding
and covers anything from brain tumors, and vitamin C to depression.In
terms of Usenet groups, research has indicated that half of the top 10
Usenet groups are concerned with a health related topic (Whitten 2001).
According
to a recent Harris Poll, statistics suggest that there are 70 million consumers
who are logging on to the Internet to learn more about their health (Wellner
2000).This means that close to three-quarters
of the entire online population is seeking information about their health
or the health of their loved ones.In
addition to simply looking for information, in 1999 consumers purchased
$93 million dollars in over-the-counter-medicine online (Wellner 2000).Projections
suggest that by 2004 this number will have reached nearly $2 billion dollars
in the United States (Wellner 2000).The
majority of information and medication searched for online is for serious
health problems.Cyberspace has not
been able to communicate information about less serious conditions such
as the flu or the common cold to consumers (Wellner 2000).
Another
trend that is developing, beyond the purchase of online drugs, is that
consumers are researching those prescribed drugs online.In
fact, 82% of patients believe that the Web offers better information on
new medication than their doctor or pharmacist (Lach 1999).A
great majority of patients are visiting the Web sites of pharmaceutical
companies in order to research a drug that may aid in the treatment of
their health condition.However,
doctors are concerned that consumers are not able to distinguish between
the promotional aspects and the educational aspects of the drug information
contained on the pharmaceutical companies Web site (Lach 1999). While there
are no examples or statistics given to illustrate this claim, it is a major
concern that doctors have regarding the availability of drug related information
online.
Practitioners
in the medical profession are also concerned with misrepresentation over
the Internet as well.Internet-based
clinical services could increase the likelihood that medical credentials
will be misrepresented on the Internet, or that patients not seen in person
will be more likely to fake symptoms in order to obtain a variety of prescription
drugs (Whitten 2001).
Those consumers
seeking information on health related problems are referred to in the literature
as “health seekers” (Fox & Rainie 2000).Consumers
are most likely to seek out information in relation to fighting illness
and learning more information about the treatment and prognosis for their
illness (Fox & Rainie 2000).In
terms of demographics, current research has illustrated that health seekers
are more likely to be members of minority groups and are from households
with a family income under $50,000 (Fox & Rainie 2000).Research
has further demonstrated that 63% of health-seekers are women, 59% are
parents, and 59% have been accessing the Internet for more than three years
(Fox & Rainie, 2000).Other researchers
have found that health seekers are more likely to be college graduates
between the ages of 30 and 64 (Wilkins & Navarro, 2001).The
current demographic information has not confirmed the existence of a digital
divide in the access to Internet information.Despite
the different characteristics of health seekers on the Internet, they have
one common goal that is finding information on the Internet to allow them
to make more informed health care decisions.
Consumer Empowerment
The increased
access of consumers to health related information on the Internet was first
heralded as an achievement that would greatly empower consumers in making
decisions regarding their health.However,
concerns have risen with respect to the quality of information on the Internet.More
and more medical and health information is available on the Internet, and
much of this information is unidirectional in nature, presented to consumers
in a non-interactive format similar to a pamphlet (Slack 1997). While the
American Medical Association Web site contains accurate and high quality
information, there are Web sites that contain information that is not accurate,
or of high quality, and has not been authored by medical professionals.
The Federal
Trade Commission estimates that doctors only review half of the content
on health and medical web sites (Fox & Rainie 2000), demonstrating
that medical professionals are not a major source of health information
on the Internet (Eastin 2001).Health
information on the Internet often contains misinformation and unfounded
opinion due to a lack of censorship on the Internet (Slack 1997).In
fact, there are no government regulations concerning health information
on the Internet.Increasing numbers
of consumers are seeking medical advice from personal Web pages and chat
rooms.The potential for consumer
harm could outweigh the empowering effect that the Internet was supposed
to give to health care consumers.
Health
seekers themselves have confirmed that they have concerns about the quality
of the information they are finding on the Internet.In
fact, 82% of health seekers are concerned about the reliability of the
source of their health related information (Fox & Rainie 2000).
Beyond the potential hazards
from unreliable treatment information is the fact that information on the
Internet could lead consumers away from proper care options (Eastin 2001).
Unfortunately, there are no statistics on the number of patients that have
been led away from proper treatment options, only theorizing on what is
likely to happen in response to the questionable quality of health related
information on the Internet.
Researchers
are concerned that consumers limited knowledge of health related information
and their difficulties in assessing the quality of health information could
lead consumers to rely more on message-inherent heuristic cues such as
language style or Web site attractiveness in an attempt to critically evaluate
the messages presented.Persuasion
research has confirmed that knowledge mediates the ability of consumers
to critically evaluate the messages that they are presented with (Eastin
2001).When consumers are highly
knowledgeable, their ability and motivation to process the message is higher
and their critical interpretation skills are heightened allowing them to
better judge the validity of the information.
Unfortunately,
consumers are not highly knowledgeable about health related information,
and may have difficulty in assessing the credibility of health related
messages. Eastin (2001) assessed these issues in an experiment with undergraduate
students.Students viewed one of
two Web sites and made judgements about the credibility or source expertise
of the source of the health related information.Results
demonstrated that students were evaluating unfamiliar information on the
Internet using the source of the message as a cue for the quality of the
message.Specifically, consumers
give more credibility to a Web site authored by a doctor treating an AIDS
patients versus a Web site authored by the family of an AIDS patient. Eastin
(2001) suggested that these results help to alleviate some concerns that
consumers are not separating reliable from unreliable information.
A number
of professional organizations have begun to examine the issue of the quality
of health information on the Internet.Their
aim is to develop a number of policies or criteria that could help in controlling
the quality of information on the Internet or to help in informing consumers
on how to better assess the credibility of information on the Internet.
One interesting development in the movement to protect consumers from unreliable
information on the Internet is called Quackwatch
(Hardey 1999).The mission of Quackwatch
is to warn consumers about the potential for unscientific or inappropriate
health information on the Internet and was started by a retired psychiatrist
and a number of sympathetic doctors in the United States.
The Health
Improvement Institute has organized a series of workshops to address
concerns about the quality of health information on the Internet (Goldschmidt
& Liao 1998).Representatives
were included from over 60 health care, Internet, consumer interest, government
and public health organizations.One
of the main issues was how to enable consumers to evaluate the information
on health related Internet sites.There
were two solutions put forward.The
first solution was aimed at Web site creators and called for accurate and
balanced information to be presented on Web sites including the name of
the company or authors of the information (including credentials), the
date the site was developed, the frequency of updates to the site, and
the basis for any health related claims put forward.The
second solution was directed towards the software development industry
asking them to help consumers judge the health information that is presented
through a series of rating systems and filtering software that would direct
consumers to higher grades of health information (Goldschmidt & Liao
1998).
The
Health
Summit Working Group was also convened in order to develop a number
of criteria that could be used for evaluating Internet health information,
and seven criteria were decided upon (Anonymous, 1999).First,
the source and editorial review process of the information should be credible.Second,
the content of the information must be accurate and complete with a disclaimer
provided if needed.Third, disclosure
information relating to the purpose of the Web site should also be included.Fourth,
hyperlinks on the Web site to other Web sites should be evaluated according
to selection, architecture, and content.Fifth,
the Web site should be designed to be navigable, accessible, and have an
internal search capability.Sixth,
the site should be interactive and include feedback mechanisms as a way
to exchange information between users and the health-care providers.And
finally, there should be caveats included that explain the sites function
(Anonymous, 1999).It was believed
that if these criteria were used in the creation of health related Web
sites, consumers would have enough information available to adequately
judge the quality of the provided information.Unfortunately,
the main focus of this endeavor was on how to develop Web sites to allow
consumers to judge the quality of the health information.There
was no consideration given to the actual evaluation of health related Web
sites to see which ones did and did not meet the established criteria.
Beyond
the quality of the information on the Internet, other researchers have
examined the stability of information on the Internet.Web
sites come and go fairly frequently and if consumers were relying on the
information at a particular Web site and it shuts down, they are now at
a loss.Researchers have been interested
in the characteristics that influence the survival of health related Web
sites.Previous research had indicated
that the overall survival rate had dropped to 40% (McMillan 2001).Interestingly,
military, government, and non-profit Web sites had an overall 80% survival
rate, twice that of other Web sites and this was one dimension of the current
research (McMillan 2001).It was
believed that there were characteristics inherent to military, government
and non-profit Web sites that did not characterize other sites.The
current longitudinal study began in 1997 with an email survey to a randomized
number of health related Web sites (McMillan 2001).The
author followed up with the Web site manager’s three years later and asked
a number of questions about the managers’ perceptions of the reasons behind
their Web site survival.Some of
the factors that led to the survival of the Web site were the investment
of money, personnel and time in the development and maintenance of the
Web site.Another important factor
was the commitment of the organization to the Web Site.Those
organizations that did not commit resources to the Web site were more likely
to fail within the three-year follow-up period.The
overall survival rate was 60.5% in the current research, and is higher
than demonstrated previously and did not confirm the higher survival rates
for government and non-profit Web sites (McMillan 2001).While
this research highlights important factors that contribute to the stability
of health information on the Internet, a more important contribution of
this research could have been made.In
particular, if researchers had examined whether the quality of the health
related information was a contributing factor in the survival of the Web
site, we would have been able to draw more solid conclusions about the
factors contributing to health Web site survival.
In addition
to these concerns of consumer protection groups and medical professionals,
health seekers on the Internet are concerned with anonymity and online
medical record privacy.Anonymity
is of great concern to consumers seeking health related information on
sensitive topics.Beyond concerns
about embarrassment, health seekers do not want others to be aware of their
medical conditions and appreciate that they can gain medical information
anonymously.In a series of telephone
interviews, 89% of health care consumers indicated that that they were
concerned that a health Web site may give away or sell information about
what they did online (Fox
& Rainie 2000).Consumers were
even concerned that their job status or health insurance could be affected
by what information they were seeking online (Fox & Rainie 2000).In
an attempt to protect themselves, 24% of health-seekers report that they
used fake names in order to gain access to health related Web sites and
get the needed information (Fox & Rainie 2000).
Privacy
concerns regarding the accessibility of medical records online have also
been identified for health care consumers (Flower & Guillaume 2001).Right
now there is little legal protection for health information, online or
offline.Contrary to laws concerning
the privacy of financial records and credit reports, there is no comprehensive
federal law protecting medical records in the United States (Fox &
Rainie 2000).Patients are concerned
that employers and health insurance providers may access medical records
and use it against them.However,
doctors contend that easy access to a patients comprehensive medical history
could save lives, reduce the chance of medical errors, and improve communication
between different doctors who may at times treat the same patients under
different circumstances (Fox & Rainie 2000).There
is a long and continuing debate about the accessibility of medical records
online that may not be solved until it is addressed legally through the
development of privacy laws and technologically through the development
of software to restrict access.
Today’s
health care consumers have unprecedented access to health-related information
and are demanding more involvement in their own health care.However,
some authors believe that the trend towards empowered consumers is being
overstated.These authors contend
that the Internet has not created a new breed of health care consumer,
instead it has created a new medium of information that health seeking
consumers can utilize (Wilkins & Navarro, 2001).It
is suggested that health seekers still look for high quality health information
that is consistent with their values and priorities just as they did before
the introduction of the Internet.
The Problem of Access
In
addition to issues relating to consumer empowerment, questions have been
raised about the access of some consumers to health related information.On
one hand, consumers that are in rural areas or in areas with less developed
services can benefit from getting information on the Internet about their
health problems (Hardey 1999).Patients
in far remote communities have the opportunity to participate in self-help
groups with others sharing similar illness experiences that they would
have not been able to do in the past (Mechanic 1999).Telemedicine,
the practice of remote medical consultation, also has the ability to increase
the medical service that rural area patients receive (Slack 1997).However,
there is some concern that computers and the Internet will result in the
dehumanization of modern medicine (Katz 1976).
On
the other hand, there is a concern over restricted access to Internet health
care services for those citizens who are in the poorer segments of society.Recent
research suggests that 91% of online health care consumers have health
insurance (Fox & Rainie 2000).Unfortunately,
there are an estimated 47 million Americans who have no health insurance
and little or no access to health care (Sorensen 2001).There
is a substantial amount of evidence that suggests the uninsured population
in the United States, which is on the rise, has less access to health care
and poorer health care outcomes than those individuals who have health
insurance (Sorensen 2001).An additional
problem is that a recent examination of health related Web sites confirmed
that these Web sites require at least a high-school level reading ability,
and more than half of them present material at the college level (Sorensen
2001).Even in cases where access
to the Internet can be increased for those with low incomes or no health
insurance, there are other issues such as functional, information, and
occupational literacy that will serve as barriers to the effective use
of the information on the Internet (Sorensen, 2001).And
of course, there is still a problem with the accuracy of the health information
on the Internet.
Besides
the issues of access to health information on the Internet, those patients
with preventable and manageable health problems do not always have access
to health services.Some of the greatest
challenges are transportation problems and emotional and physical handicaps
(Whitten 2001).None of these access
problems can be solved with the introduction of the Internet.On
the other hand, there is the potential that the relative inexpensiveness
of the Internet could allow the diversion of resources to those still existing
access problems.Mechanic (1999)
maintains that there are “many missed opportunities for prevention by more
rational allocation of services” (p.713).In
the long-term will the effect of the Internet upon the empowerment of health
care consumers be good or bad?From
our current standpoint, it seems that the Internet will increase the health
benefits for those people who are educated and have health insurance, and
make it even more difficult for those marginalized members of society to
gain access and understanding to health related information.
Changing the Doctor-Patient Relationship
The introduction
of the Internet into the health care system has been suggested as a contributing
factor in the changing power dimensions between doctors and patients.The
power dimension that is characteristic of the doctor-patient relationship
has been perpetuated by a number of factors (Weiss & Lonnquist 1994).First,
there is professional prestige that is based in part on the physicians’
medical expertise and their role as the ultimate authority on health matters.Second,
there is an element of situational authority and dependency involved in
the interaction between doctors and patients as the doctor is providing
service to someone who is in need of help, and the patient is dependent
on the physician and their resources.Third,
the doctor is often the one to control the communication flow with the
patient and makes most if not all of the important decisions.Many
doctors tend to talk down to their patients, are abrupt with them or interrupt,
and rely on complicated jargon to impart medical information to patients.Research
has suggested that many patients misunderstand the message that is being
communicated partly due to the language that is used to impart it (Weiss
& Lonnquist 1994). Fourth, the setting of the medical encounter is
not conducive to making the patient feel at ease and often maintains a
physical distance between the doctor and the patient.Finally,
the length of the medical encounter has been estimated as quite low (10
to 15 minutes on average) and often patients do not have enough time to
discuss all of their concerns.These
characteristics serve to contribute to a different level of power between
doctor and patient and it is expected that the availability of health information
on the Internet will change these power dimensions.
The unprecedented
access to health information on the Internet has the potential to influence
the nature of the relationship between doctors and patients (Slack 1997).At
the very least, patients will participate more in decisions regarding their
health (Hardey 1999: Mechanic 1999), and have more control over their own
health care decisions (Cullen 1998).Slack
(1997) maintains that doctors should give their patients enough information
to enable them and their family to make informed decisions regarding their
health.The availability of computers
and improved computer software offer patients more opportunities to assess
their health risks, for example, some software programs that give patients
information about the pros and cons of various intervention choices that
they can choose to treat breast cancer (Mechanic 1999).
Patients
are turning towards the Internet as a way of participating in what the
medical community refers to as “shared decision-making” (Fox & Rainie
2000). While doctors now tend to have a “god-like” power and the ability
to make autonomous decisions, in the future it is believed that doctors
will have to share power and make decisions using consensus (Anonymous,
1995).In fact, recent research illustrated
that 50% of health seekers asked their doctor new questions regarding their
treatment or sought a second opinion after encountering information on
the Internet (Fox & Rainie 2000).Furthermore,
28% of health seekers indicated that the health information they received
online influenced their decision about whether or not they would see a
doctor for their condition (Fox & Rainie 2000).The
doctor-patient relationship is expected to change to more of a team effort
between doctor and patient as opposed to a one-sided consultation (Bickers
1999).Some authors conclude that
tomorrow’s doctor will be more like an advisor or teacher (Anonymous 1995).It
seems that the burden of responsibility in the health care system has shifted
to patients and now patients are expected to become more assertive with
respect to their healthcare needs. The question that we are left with is
how consumers will face these new challenges and participate in their health
care decisions.
Changes in the Power Held by the Medical Profession
In
the past, medicine as a profession has been characterized by two different
dimensions of power: autonomy and dominance (Allandale 1998).Autonomy
refers to the ability of those in the medical profession to have control
over their own work activities.Dominance
refers to the control that doctors have over the work of others in the
health care division of labor such as nurses or lab technicians (Allandale
1998, Weiss & Lonnquist 1994).The
literature has suggested that some medical professionals use their expertise
and knowledge to maintain their positions of power in relationships with
others.There are two threats to
this power relationship: proletarianisation and deprofessionalisation both
of which are being affected by the availability of health information on
the Internet (Hardey 1999).Proletarianisation
refers to the “process whereby organizational and managerial changes divest
professions of the control they have enjoyed over their work” ((Hardey
1999, p.821), and is closely related to what Allandale (1998) and other
theorists refer to as autonomy.In
fact, there have been claims that the new “cybermedicine” is being used
by management in order to place limits on the freedom that doctors have
enjoyed in the past (Hardey, 1999).New
medical technologies have also served to decrease the need for some skills
and have made work more routinized for doctors thereby contributing to
proletarianisation (Weiss & Lonnquist, 1994).
Deprofessionalization
refers to a loss of monopoly over knowledge and expectations of authority
over clients (Allandale 1998).Deprofessionalization
has been associated with a demystification of medical expertise, and increased
skepticism about health professionals due to the availability of health-related
information on the Internet (Hardey, 1999).It
is argued that an increasingly educated and critical population of health
care consumers contributes to deprofessonalization through what has been
referred to as a “revolt of the client”, in which patients begin to challenge
their physicians authority (Weiss & Lonnquist, 1994, p.228).Not
only has the dominion of doctors over patients become smaller, but the
public seems to have lost confidence in the service orientation of the
medical profession (Weiss & Lonnquist, 1994).
In the
past, those in the medical profession attempted to control knowledge and
stay ahead of the general population by dividing up knowledge and maintaining
the monopoly upon knowledge through specialization (Annandale, 1998). The
Internet is a new medium in which expert knowledge is accessible to anyone
with a networked computer (Hardey 1999).The
Internet has been seen as a threat to the medical profession in that it
provides a wide variety of health-related information that detracts from
the expert knowledge that doctors hold (Hardey 1999).In
fact, while today’s doctor tends to be a specialist, the doctor of tomorrow
is more likely to be a generalist who treats the entire family (Anonymous
1995).
One
unanticipated outcome of the Internet upon the practice of medicine is
that the computer-mediated presentation of material to consumers can give
the illusion of authority (Hardey 1999).It
has been suggested that this illusion of authority may serve to give alternative
or unorthodox medical practices the symbols and power that are associated
with orthodox medicine (Hardey 1999).There
is a concern that consumers may decide to follow treatment suggestions
on the Internet that they would not have otherwise believed had they encountered
the information elsewhere.However,
some theorists maintain that alternative medicine has been receiving greater
consumer interest since the 1960’s, and the demand that is arising for
these health care alternatives will help them to achieve a place in mainstream
society (Saks 2001).Moreover, increased
exposure to credible information regarding these alternative medical practices
can help to alleviate fears regarding alternative medical practices such
as reflexology and aromatherapy that have received the label of “unorthodox”
(Saks 2001).
Changing Relationships Between Doctors and Other Health Care Providers
The introduction
of the Internet has the potential for far reaching changes beyond the doctor-patient
relationship and the power held by the medical profession.Researchers
have suggested that doctors today are more connected than ever before.Colleagues
can reach one another via email and discuss treatment issues regarding
their patients (Fox & Rainie 2000).In
fact, there are plans to connect medical professionals in a number of countries
with access to research information, drug directories, medical news and
useful industry sites (Hardey 1999).
One of
the main goals that doctors have is for the current trends in technology
and service is to enable them to practice medicine more effectively and
more efficiently (Given 2001). Currently, 50% of doctors use the Internet
daily, however only 20% of them feel that is necessary to their practice
of medicine (Sandborn 2001).Despite
these statistics, research indicates that doctors want to utilize the Internet
for the chance that it gives then to improve their productivity (Sandborn
2001).
The introduction
of the Internet has the potential to influence the relationships among
doctors.Research has investigated
whether doctors participate more like a community through their communications
with each other over the Internet.One
electronic discussion group for general medical practitioners in the United
Kingdom was monitored in order to determine what similarities existed between
this virtual medical community and traditional communities (Fox & Roberts
1999).The research was interested
in the impact of computer mediated communications on the social and professional
relationships between medical practitioners in the United Kingdom (Fox
& Roberts 1999).The list had
between 196 and 443 participants generating approximately 20 messages per
day during the one year that the authors monitored the discussion group.
Results
indicated that the electronic discussion group generated discussions that
could be categorized into a number of categories including information
offering, information request, opinion offering, opinion request and formative
messages that helped to establish and sustain interactions between the
doctors (Fox & Roberts 1999).There
were frequent and popular discussions that continued on for long periods
of time concerning the pressures facing doctors as well as the psychological
and social stress that recent government reforms had placed upon them.For
example, one of the discussants stated that:
I often
think that the main reason for the distress of many GPs these days lies
not so much in our working conditions and pay as in the pressure upon us
to change our culture.We are in
a position analogous to a subject people which as been taken over by a
colonial power which not only wishes to change our behavior, but believes
that its attitudes and culture are superior (p.654, Fox & Roberts 1999).
Doctors were able to share
experiences with others in similar circumstances, and commiserate with
one another in a supportive community.In
addition, participants in the electronic discussion group welcomed the
freedom of expression that was allowed (Fox & Roberts 1999).
Like many
traditional communities, social norms developed in this community that
were important in structuring communication and facilitating discussions.Specifically,
there were reminders that the discussion group was an “academic list” and
members were encouraged to reply to one another personally when a list
wide reply would be inappropriate (Fox & Roberts 1999).Some
of the more informal norms that emerged in the group included the convention
that new members were to “lurk” a while before contributing to the discussion
as a way of learning the mores of the list (Fox & Roberts 1999).This
practice of lurking would allow new members to learn most of the rules
of interaction and the common abbreviations used by the group.
The social
and power relations of general medical practice were reflected in the primarily
male composition of the discussion group and the exclusion of patients
from the list (Fox & Roberts 1999).Other
characteristics that emerged through the research suggested that some members
were striving to establish themselves as technical computing experts.Unlike
other virtual communities, there was no evidence of identity-bending or
gender-bending.This was perhaps
a reflection of the published objectives of this discussion group as being
for academic purposes.The doctors
in this group also voiced concerns that new technologies would contribute
to the deregulation of medicine and would cause further problems in power
relationships within the discipline (Fox & Roberts 1999).Finally,
there was evidence that many friendships developed within this discussion
group in a similar fashion to the development of friendship in a face-to-face
community.It is this collegiality
of the group that led them to invest in their virtual interactions, to
develop a spirit of trust, responsibility and ongoing commitment to one
another (Fox & Roberts 1999).
In addition
to the changing relationships between doctors practicing medicine, there
are changing relationships between doctors and other health care practitioners. Researchers
have suggested that the boundaries between medicine, nursing and management
are currently in a state of flux (Annandale 1998).In
fact, new roles are emerging such as the physician-manager and the advanced
nurse practitioner that transcend previous boundaries between these professions.In
the past, nursing has suffered from a lack of power that has been partially
linked to the gender-blind nature of research on power as the majority
of nurses are women (Annandale 1998).
It has been
held that nurses have accepted a lower place on the hospital’s status hierarchy
in exchange for the ability to practice nonscientific, nurturing care that
has no place in medicine (Katz 1976).The
nurse’s role is usually to go along with the decisions made by the doctor
and to convey the same level of optimism as the doctor to the patient regardless
of their circumstances.Often there
are cases in which the nurse has more information about the patient than
the doctor does because of the increased frequency of contact, however
the nurses’ knowledge is considered to be less valid and less educated
than the doctor (Katz 1976).
It has been
suggested that the traditional distinction between nursing as care and
medicine as treatment is blurring (Annandale 1998).Unfortunately,
most of this work on the changes to the relationship between doctors and
other health care providers with the advent of the Internet it theoretical
in nature. It is hoped that effort will be directed towards empirically
establishing these emerging relationships.
Practitioners of alternative healing and medical
practices suffer some of the same status difficulties that nurses face.Alternative
therapists and their professional organizations have typically been marginalized
in the occupational structure of health care (Saks 2001). The response
on the part of the dominant leaders in the medical profession in the West
has remained negative in part due to the fact that these non-traditional
therapies pose a threat to medical interests at a variety of levels.Neo-Weberians
maintain that the privileged position that some occupations hold in terms
of income, status and power has been derived from a legally based market
regulation that centers on the accreditation given to the medical profession
from various licensing organizations (Saks 2001).Alternative
medical practitioners have attempted to challenge this health care division
of labor by moving towards the accreditation of alternative therapies through
the development ethical standards and voluntary codes of conduct (Saks
2001).
The marginal position that alternative medical
practices hold in the medical division of labor is changing.In
Britain for example, political support by Prince Charles has aided in the
enhancement of the profile of alternative medicine in general (Saks 2001).Doctors
who have begun to combine alternative therapies with the practice of orthodox
medicine are also influencing the division of labor in the West.In
fact, the USA medical profession has tended to be less defensive in regards
to the incorporation of alternative medicine (Saks 2001).However,
one can not be sure that these changes are at all related to the development
of the Internet.In time, we are
likely to be better able to determine the exact nature of the impact of
the Internet upon health care.
Changing the Health Care Organization
The
rising cost of health care and other welfare services has increased the
burden on many governments as they attempts to provide care.Many
researchers have held that the implementation of new technologies can increase
efficiency and reduce costs in the long-term, although the short-term costs
are higher (Cullen 1998).Unfortunately,
health care organizations spend only two percent of their budgets on computers
and technology versus ten percent for other business sectors (Flower &
Guillaume 2001).Despite some budgetary
constraints, governments and health care providers are exploring a number
of ways that they can change the administrative and organizational structure
of health care using information technology.One
attempt at restructuring is to encourage a shift away from the use of resources
for the inpatient sector and toward primary, community, and self-managed
care (Cullen 1998).There is also
a move to increase outpatient facilities and to facilitate more preventative
medicine through social awareness campaigns (Cullen 1998).
Beyond
the obvious increased reliance on computers for the storage of data, there
are more Internet based solutions that are being integrated into the health
care system (Cullen 1998). Some Internet based solutions include: teletraining
(distance teaching and training within the medical profession); telediagnosis
(carrying out remote medical consultations); telemergency (coordinating
and operationalizing emergency service interventions); teleradiology (using
telecommunitions to send and diagnose medical images); and telepathology
(transmitting laboratory results to experts in other areas) (Cullen 1998).The
use of these services can enhance the knowledge and competence of nonspecialist
health professionals and may contribute to the erosion of “consultant power”
(Cullen 1998).
Conclusion
The health
care system is changing, and in the future it will draw on resources from
a number of health care professionals such as nurse practitioners, physical
therapists, physician assistants, pharmacists and others (Anonymous 1995).Health
care practitioners will coordinate their efforts and work as an integrated
team to provide the best and most appropriate care to their patients.The
doctor of the future will need the leadership skills to coordinate this
team, as well as the ability to make use of the Internet and information
technology that will allow them to provide the best of care to their patients.Future
efforts should be directed towards empirically measuring how the Internet
is affecting the health care system.
References
Anonymous
1999 Assessing the Quality
of Internet Health Information. A Summary, Agency for Health Care Policy
and Research, Rockville, MD, and Mitretek Systems, McLean, VA,
http://www/ahcpr.gov/qual/hiirpt.htm
Anonymous
1995 Tomorrow’s Doctor Must
Share Power, Report Concludes, Health Care Financing Review, 17(2):297-298
Annandale, Ellen
1998 The Sociology of Health
and Medicine: A Critical Introduction, Cambridge, UK: Polity Press
Bickers, Charles
1999 E-Health Hits Asia,
Far Eastern Economic Review, 47:88
Cullen, Joe
1998 The Needle and the Damage
Done” Research, Action Research, and the Organizational and Social Construction
of Health in the “Information Society, Human Relations, 51(12):1543-1564
Eastin, Matthew
2001 Credibility Assessments
of Online Health Information: The Effects of Source Expertise and Knowledge
of Content, Journal of Computer Mediated Communication, 6(4):1-14
Flower, Joe and Patrice Guillaume
2001 Health: Eight Power
Factors , Three Scenarios, Health Forum Journal, Jan, 13-16: 45
Fox, Nick and Chris Roberts
1999 GPs in Cyberspace: The
Sociology of a ‘Virtual Community’, Sociological Review, 47(4):643-671
Fox, Susannah and Lee Rainie
2000 The online health care
revolution: How the Web helps Americans take better care of themselves,
The Pew Internet and American Life Project, http://www.pewinternet.org/
Given, Ruth
2001 Taking the Pulse: Physicians
and the Internet, Deloitte Consulting,
http://www.dc.com/obx/pages.php?Name=taking_the_pulse_summary
Goldschmidt, PG, and Liao, J.
1998 Quality of Health Information
on the Internet -Enabling
Consumers to Tell Fact from
Fraud, Bethesda, MD: Health Improvement Institute, http://www/ahcpr.gov/qual/hiirpt.htm
Hardey, Michael
1999 Doctor in the house:
the Internet as a Source of lay Health
Knowledge and the Challenge
to Expertise, Sociology of Health and Illness, 21(6):820-
835
Katz, Fred E.
1976 Harnessing Knowledge
Amid Status Struggles: The Case of Nurses in Hospitals, In Structuralism
in Sociology: An Approach to Knowledge, Albany, NY: State University of
New York Press, pp.172-185
Lach, Jennifer
2000 Diagnosis for 2010,
American Demographics, 22(1):16-19
Lach, Jennifer
1999 The Web Doctor is In,
American Demographics, 21(7):20–22
McMillan, Sally
2001 Survival of the Fittest
Online: A Longitudinal Study of Health-Related Web Sites, Journal of Computer
Mediated Communications, 6(3):1-32
Mechanic, David
1999 Issues in Promoting
Health”, Social Science and Medicine, 48:711-718
Saks, Mike
2001 Alternative Medicine
and the Health Care Division of Labor: Present Trends and Future Prospects,
Current
Sociology, 49(3): 119-134
Sandborn, Grant
2001 Internet industry challenged
to provide physicians with Valuable OnlineApplications,
Deloitte Consulting, http://www.dc.com/obx/pages/php?Name=pr_cyberDialogue
Slack, Warner V.
1997 Cybermedicine: How Computing
Empowers Doctors and Patients for Better HealthCare,
San Francisco: Jossey-Boss Publishers
Sorensen, Andrew
2001 Promoting Public Health
Through Electronic Media: A Challenge for Schools of Public Health, Health
Policy and Ethics Forum, 91(8):1183-1185
Weiss, Gregory L. and Lynne E. Lonnquist
1994 The Sociology of Health,
Healing and Illness, Englewood Cliffs, New Jersey: Prentice Hall
Wellner, Alison
2000 Casting the Health.Net,
American Demographics, 22(3):46–50
Whitten, Pamela
2001 Ehealth: Market Potential
and Business Strategies, Journal of Computer Mediated Communication, 6(4):1-22
Wilkins, Stephen and Frederick Navarro
2001 Has the Web Really Empowered
Health Care Consumers?, Marketing Health Services, 21(3): 5–9
Kelley Main
University of Manitoba
December 8, 2001