With Covid, technology has proved to be a lifeline. But it has also profoundly changed the way of relating between doctor and client. The survey on time.news
Hear the voices of the patients: With the use of technology you had a improving the efficiency and effectiveness of all services in the relationship with the doctor. Some doctors have “taken advantage” of the distancing imposed by the pandemic in order not to make themselves available neither in presence, nor at a distance. In the era of pushed polarization (also by the omnipresence of social networks), perhaps this was to be expected. But the result of a swave promoted by Corriere Salute on time.news in collaboration with the Giancarlo Quarta Foundation – and presented at Tempo della Salute 2021 – confirms how divisive the topic of technological innovation in healthcare can become.
Telemedicina, chat, email
Over 5 thousand readers replied to the questions that wanted to measure the pulse to the relationship between general practitioners and patients. Obviously they could not miss it questions on the impact that tools such as telemedicine, or chats (such as WhatsApp) or simple emails, have had on the relationship between cured and carers. A theme, that of digital innovation in healthcare, is now unavoidable, as demonstrated by the National Recovery and Resilience Plan (PNRR) which has earmarked 7 billion euros for the development of proximity networks, structures and telemedicine for local health care, and 8.63 billion for innovation, research and digitalisation of the National Health Service.
Measure the change
The goal of the survey was to measure and understand the effects of the pandemic on the doctor-patient relationship, especially the general practitioner, who due to the distancing has changed even more, he explains. Alan Pampallona, director of the Giancarlo Quarta Foundation who analyzed it. There are three elements around which the survey moves: the patient as he perceived himself, changes in your doctor’s perception and finally a series of open questions about improvements and worsening who had brought about this situation and the suggestions. Overall, about 5,757 questionnaires were collected, divided between the various sources. Of these, around 4,800 respondents have consulted their doctor in the past 12 months and answered questions. The average age of participants was 60 years, equally distributed between men and women, more in the North West, high school level and professionally very active.
Pessimists and optimists
Before deepening the relationship with the doctor, the interviewee was asked what state of mind he was in thinking about his health. Two worlds have emerged: patients who, for all the situations described, declare themselves pessimists and those who are optimistic, emphasizes Pampallona. The conclusions? the pandemic, but I believe not only in the doctor-patient relationship, it wasn’t the cause of a crisis but more of a magnifying glass which highlighted certain aspects. it was a detonator, of criticism, for some, or an aggregator of positivity, for the others. Different worlds and different perspectives were highlighted even on objective data such as the too high number of patients: those who are dissatisfied say that the doctor must be relieved; those dissatisfied say that an excuse not to interact with the patient specifies Pampallona.
Speed and comfort
Yet among the suggestions made by the interviewees to improve the quality of the relationship with the doctor, the following emerged: spreading telemedicine as a solution to some problems in the health sector and continue with the use of electronic prescriptions and computerized medical records. Why? Speed and comfort. The measures taken made it possible to reduce waiting times and make services more effective. Regarding the electronic prescription, another cornerstone of the National Health Service, was highlighted as the prescriptions sent via email and the Electronic health record represent an innovation that simplifies and speeds up processes. As for new technological means, with the introduction of new communication channels, such as chat in particular, the patients perceived the doctor as more present and closer.
Facilitated contacts
The official position of unions such as Fimmg (Italian Federation of General Practitioners) e scientific companies such as Simg (Italian Society of General Medicine) has always been of maximum openness towards the digitalization of healthcare. Even the 2021 Report of the Digital Innovation in Healthcare Observatory, Politecnico di Milano (here the article that explains it in detail), has recorded an increase in the interest and use of telemedicine applications by doctors compared to the lukewarm reactions – when not marked by a certain resistance – that emerged in previous editions. So if before the Covid-19 emergency the level of use was just over 10%, during the emergency it tripled, exceeding 30% for many applications.
The testimony of the general practitioner
A testimony for all, that of Antonella Ferrari general practitioner in Milan, maximalist with 1,750 patients who follows at all hours even from home, thanks to technology. I have been a general practitioner for 22 years and it was a desired and decided professional choice with great commitment – he underlines -. The pandemic has changed our business, but also in a positive way. My patients can contact me via WhatsApp. Surely the absence of a doctor is an unspeakable fact, but not everyone works like this: out of 100, 50 maybe you won’t find them but 50 if you never talk about them.
These technological systems have allowed us to be contacted by patients you did not hear before, for example teenagers. Furthermore, I was amazed to see that these digital channels are not only used by young people or by middle-aged people but also by the third age. I think the survey data shows one thing: either you have this doctor-patient relationship or you don’t. If you have it, if you have it, a real sharing of the path of care and therapy. Technology has allowed in physical distance to have a moral closeness that if you do your job well, unique.
The experience of the specialist
At the San Raffaele hospital in Milan, where Professor Valentina Di Mattei, head of Clinical Psychology, University of Life and Health, telemedicine was introduced as early as 2018. Supportive therapies When the pandemic broke out, we were ready. Patients admitted to hospital found themselves alone, but through telemedicine we had the opportunity to put them in contact with families. Therefore, telemedicine is a tool that in this moment preserves the doctor-patient relationship more. We have also started using it with healthcare professionals.
I followed several very young people, including a 22-year-old nurse, who graduated in January 2020 and entered a Covid department in February, who told me a particularly challenging professional experience, to put it mildly. We started in the hospital and continued remotely. The sessions took place on rest days, so he was not forced to stop at the end of the shift (12 hours) or to return to the hospital, thus bypassing two of the main obstacles in supportive therapies with health personnel.
How essential is the doctor’s touch
How can the effects of remote medicine be framed? from a psychological point of view? Telemedicine is in fact an instrument of treatment and in this year and a half we have actually studied and deepened it because, as a tool, is part of a concept very dear to psychology that the “setting”, that is, that kind of frame that facilitates the unfolding of the relationship. The fundamental rules of the setting are neutrality and distance, also and above all understood as relational distance: how close it is to be close to the patient for the relationship to be effective, replies the teacher. Valentina Di Mattei.
The touch, the remedy and the word
What kind of evolution have these tools had in the relationship between doctor and patient? Going back to the past, we end up in Hippocrates even describing medical action in three basic steps: the touch, the remedy and the word. The classic touch semeiotica, the visit through palpation. The remedy represents the therapy. The word instead of telling, dialogue with the patient with respect to his situation. Coming closer to us, more or less in the 1960s, the French philosopher and sociologist Michael Focault he took up this theme of touch, of going to touch, of the doctor’s finger touching the patient. And indeed in recent medicine we have witnessed a distancing of the doctor from the patient.
Removals
The first removal occurred following theaffirmation of diagnostics, whose progress has meant that the doctor has taken a step back from the semeiotics implemented through “touch”, because very often he diagnoses through observation – the gaze, said Focault – that is, looking at the results of the exams. The second departure is probably what we are seeing now through telemedicine, which physically removed the patient from the doctor. The effects of this we will surely understand with time.
Administration of s
I am reminded of what one of the most well-known psychoanalysts and the most reference for me said: the Hungarian Michael Balint which he set up the famous Balint groups (a working method intended for doctors and other nursing and assisting professions, which aims at psychological training in the relationship with the patient, the “maintenance of the caring role” and the promotion of working well-being, ed). he was the first to realize how dangerous it is for the doctor to be in daily contact with the sick and the disease. But he said a very beautiful thing: when the doctor prescribes a therapy, in reality he prescribes himself. That is, one of the fundamental components of therapy is the relationship. How much of this telemedicine tool favors or inhibits such self-administration, remains to be understood.
February 6, 2022 (change February 6, 2022 | 19:58)
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