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REVIEW
Technologies, Physician’s Caring Competency, and Patient
Centered Care : A Systematic Review
Leah Anne Christine L. Bollos, MD1, Yueren Zhao, MD, PhD2, Gil P. Soriano, RN, MHPEd1, 3,
Tetsuya Tanioka, RN, PhD, FAAN4, Hideki Otsuka, MD, PhD4, and Rozzano Locsin, RN, PhD, FAAN5PhD Student, Graduate School of Health Sciences, Tokushima University, Tokushima, Japan, 2Associate Professor, Department of Psychiatry,
Fujita Health University, Aichi, Japan, 3Faculty Member, Department of Nursing, College of Allied Health, National University, Manila,
Philippines, 4Institute of Biomedical Sciences, Tokushima University, Graduate School, Tokushima, Japan, 5Professor Emeritus, Florida Atlantic University, FL, United States
1

Abstract : This study aimed to conduct a systematic review to clarify patient understanding, understanding of
caring concepts, understanding of technology, competency to express compassion, appropriate involvement incaring, and ethical and moral attitudes and responses toward patients. This systematic review was conducted through an electronic search across PubMed, Google Scholar, MEDLINE, and Science Direct. Authors independently appraised the methodological quality of the studies using the Mixed Method Appraisal Tool. A narrative synthesis approach was used to present these findings. Nine studies met the inclusion criteria and quality
appraisal guidelines. Through thematic analysis, four major themes were identified : Technology and caring competency, Technology and patient-centered care, Empathetic skills, and Caring competency. This review has shownthat patients choose physicians considering their emotions and communicate well with them, empowering themto take responsibility of their own or their loved ones’ healthcare. In the age of technological advancement andavailability of vast sources of information, it is expected of physicians to adapt to these character priorities while
maintaining their sense of humanness, not only focusing on healing modalities, but also to guide, educate, and appropriately empower their patients toward achieving their healthcare goals. J. Med. Invest. 70 : 307-316, August, 2023
Keywords : Technological competency, Caring, Empathy, Patient-centered care

INTRODUCTION
The healthcare environment in which clinicians work andpatients live continues to dramatically change due to the recent
advancement in medical care and rapid technological development (1). Advanced technologies with quality network services
enable individuals to improve healthcare delivery and make itavailable to more and more people. Telehealth can make healthcare more effective, organized, and available (2). The growth ofMedical 4.0 technologies enhances healthcare to make better
and wiser decisions. The use of high-tech IoT devices in smart
healthcare improves the quality of the treatment process (3).
Patient centered care ideals have permeated in healthcare systems. Additionally, patient centered care has been expanded toencompass a cultural shift in care delivery, beginning with patients’ experiences entering a facility (4). Care to patients using
ever-evolving technology, patient-centered care that deeply
understands the patient is essential (5), and it is vital to conduct
healthcare with an understanding of the harmonious relationship between technology and caring (6). If healthcare providers
do not recognize and respond to these changes, they will not beable to build a relationship of trust with patients, which maylead to problems and even litigation (7, 8). Alternatively, goodpatient-centered care improves patient satisfaction and hospitalmanagement outcomes (9). However, providing care that is both
evidence-based and patient-centered requires organizations to
Received for publication February 20, 2023 ; accepted April 4, 2023.
Address correspondence and reprint requests to Leah Bollos, PhD
Student, Graduate School of Health Sciences, Tokushima University,
Tokushima 770-8509, Japan and E-mail : leahaclb@gmail.com

reflect on their current practices. It is important to recognizethat characteristics such as culture, are difficult to change, when
striving to deliver care that is both evidence-based and patient
centered (10).
Competencies required of physicians (11) include interpersonal skills, patient-centeredness, and protection of rights. It has
been reported that it is important to coordinate ongoing care,
listen to the patient’s voice, and provide sufficient scientificallyreliable information in friendly communication using plain
language that the patient can understand, and then support thepatient’s decision-making (12).
Next, a search for “patient care and procedural skills” indicated the need to provide, appropriate, and effective care to patientsand their families based on good communication (13). Educationand treating patients with compassion were noted (14). Additionally, the importance of “a sincere attitude toward patients”
and “constant efforts to improve the quality of care,” which are
fundamental to caring competence, were also noted (15).
Simply explaining to the patient or understanding of the patient is not sufficient, as it can be one-sided by the physician (16).
It is critical the physician tries to enter the patient’s world, to see
the illness through the patient’s eyes (17). No matter how much
empathy is intended, it is meaningless if it is not conveyed to theother person, patients’ perceptions of their physicians’ empathy
and caring attitude are of key importance in contributing to patient outcomes in clinical practice (18). Competency can be subdivided into empathic skills, communication skills, and the skills tobuild up a relationship with a patient based on mutual trust. Empathic skill is the approach by which the physician can elicit the
inner world of the patient and get as much information as possible
from the patient, while recognizing the patient’s problem (19).
This study aims to conduct a systematic review to clarify patient understanding, understanding of caring concepts,

The Journal of Medical Investigation Vol. 70 2023

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understanding of technology, competency to express compassion,
appropriate involvement in caring, and ethical and moral attitudes and responses toward patients.

database search retrieved. Then, full-text papers were evaluatedin accordance with the criteria for eligibility. In this review, nine
papers that used quantitative and quantitative studies wereconsidered for methodological assessment. A PRISMA flowchart
for the screening and selection procedure is shown in Figure
1. The primary reviewer (LB) screened the studies and werereassessed by two co-reviewers (GS and TT). All three reviewers(LB, GS, and TT) verified that the papers included in the review
were appropriate for inclusion, and discrepancies were settled bydiscussion.

MATERIALS AND METHODSThis review was conducted in accordance with the framework
proposed by Peters et al. from the Joanna Briggs Institute (JBI)(20). The framework includes the following nine steps : 1) Defining and aligning the objective and question ; 2) Developing3) Describing the planned approach to evidence searching,selection, data extraction, and presentation of the evidence ; 4)
Searching for the evidence ; 5) Selecting the evidence ; 6) Extracting the evidence ; 7) Analyzing of the evidence ; 8) Presenting the results ; and 9) Summarizing the evidence in relation to
the purpose of the review, making conclusions, and noting any
implications of the findings.
The review process was conducted, and the findings were
documented and reported according to the Preferred Reporting
Items for Systematic reviews and Meta-Analyses (PRISMA)
checklist (21, 22).

Quality Assessment
The Mixed Methods Appraisal Tool (MMAT, version 2018)
was used to evaluate the papers included in this review. It isa tool used to critically appraise the methodological quality offive studies : qualitative research, randomized controlled trials,
non-randomized studies, quantitative descriptive studies, andmixed methods studies (23). Based on the classifications of theappraised studies, only 2 out of the 5 available study criteria
were utilized. The screening questions for qualitative research
include : 1.1. Is the qualitative approach appropriate to answer
the research question ; 1.2. Are the qualitative data collection
methods adequate to address the research question ; 1.3. Are thefindings adequately derived from the data ; 1.4. Is the interpretation of results sufficiently substantiated by data ; 1.5. Is there
coherence between qualitative data sources, collection, analysis,
and interpretation. Screening questions for quantitative research include : 4.1. Is the sampling strategy relevant to address
the research question ; 4.2. Is the sample representative of thetarget population ; 4.3. Are the measurements appropriate ; 4.4.
Is the risk of nonresponse bias low ; 4.5. Is the statistical analysis appropriate to answer the research question?
The primary reviewer (LB) carried out the evaluation, andthe other two reviewers validated it (GS and TT). According to
the MMAT classification of evidence quality, the methodologicalquality for the included studies was generally rated as moderate
to good, ranging from 50% to 100%. Seven papers were assessedagainst qualitative criteria and two against descriptive quantitative studies. Of the 9 studies, 3 received a 75% rating, and6 received a 100% rating. Table 1 summarizes the evaluation
results from the studies.

Inclusion and Exclusion Criteria
Studies were included in the review following the inclusion criteria : 1) studies that explore patients and healthcare professionals’ perception on the provision of caring among physicians ; 2)studies that involve the use of technology on the delivery of careto patients ; 3) primary studies, including quantitative and qualitative designs.
A search was done on November 2022 across PubMed, Google
Scholar, MEDLINE, and Science Direct using the key words“technology,” “technological competency,” “patient-physician
relationship” or “patient- physician relationship,” “lived experience,” “culture” and “caring.” Research articles relevant to thecontext of this study from 1998 up to 2022 were investigated.
After discussion among co-researchers, the inclusion criteria
consisted of full-text studies written in the English language
and published in peer-reviewed journals.

Screening and selection of studies
Titles and abstracts were used to filter the papers that theTable 1. Quality assessment scores of studies using MMAT (Hong et al., 2018)
References
Methodological Quality
Criteria

Qualitative

Quantitative

1.1

1.2

1.3

1.4

1.5

Neville et al. (24)

Yes

Yes

Yes

Yes

Can’t tellMiller et al. (25)

Yes

Yes

Yes

Yes

Yes

Leung et al. (26)

Yes

Yes

Yes

Yes

Yes

Haddad et al. (27)

Yes

Yes

Yes

Can’t tellYes

Brown-Johnson et al. (28)

Yes

Yes

Yes

Yes

Yes

Bahadori et al. (29)

Yes

Yes

Yes

Yes

Yes

Mustika et al. (30)

Yes

Yes

Yes

Yes

Yes

4.1

4.2

4.3

4.4

4.5

Qualityscore (%)
75%
Fair
100%
Good
100%
Good
75%
Fair
100%
Good
100%
Good
100%
Good

Berger et al. (31)

Yes

Yes

Cannot tell, tool
validity and reliability
not measured

Yes

Yes

75%
Fair

De Rosis and Barsanti (32)

Yes

Yes

Yes

Yes

Yes

100%
Good

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309

Data Extraction

were excluded. A total of 9 articles underwent data extraction
and synthesis of the results.

Based on the data requirements, the following data wereextracted from each article, namely : study aim, design, setting,population/sample, main results, and themes derived. The main
characteristics and results of the reviewed papers are shownin Table 2. The results revealed four main themes, which help
in coding and arranging data to generate themes. The selected
themes were used to group similar findings and present them.
The first data extraction was carried out by one reviewer (LB),
and it was then discussed with the other reviewers. The review’s
themes and its findings were presented and discussed using anarrative synthesis approach.

Characteristics of the reviewed studies
The results are based on 9 studies published between 1998 and2022. Of the 9 reviewed papers, 7 employed qualitative studies(24-30), and two used quantitative studies (31, 32). The reviewed
studies were conducted in different countries, which includes
UK, Canada, Hong Kong, Guinea, U.S.A., Iran, Indonesia, Israel, and Italy. The studies employed physicians, patients, nurses,
and medical students as participants. Further information about
the reviewed studies’ characteristics is provided in Table 2.

Synthesis of the findings
Following the process of thematic analysis, four major themes
were identified : 1) Technology and caring competency, 2) Technology and patient-centered care, 3) Empathetic skills, 4) Caring
competency.

RESULTS

Search Results
The search strategy yielded a total of 273 records identified
from manual searches, PubMed, MEDLINE, Google scholar,
and Science Direct. After the selection of potential titles, removal of duplicates and studies not written in English, 114 records
remained. These records were further reduced to 46 potential
reports after reviewing the abstracts and removing studies thatwere unrelated to the study’s aims. The relevant reports were extracted and underwent a full text review, after which 37 studies

Technology and Caring Competency
Two studies that showed the theme of technology involvementwith a physician’s or physician- in training’s caring competency.
Neville et al. (24) explored the views of physicians and patientson the use of computer systems during consults, and while bothsides believed that modern technology should never be allowed
to replace face-to-face interaction during patient consultations,Figure 1. Search flowchart following PRISMA guidelines

L. Bollos, et al. Physician’s Caring Competency

310

Table 2. The main characteristics and findings from the reviewed articles.
Author / Study title
Country

Aims

Neville et al. (24)Patient and healthcare
professional views andexperiences of computer
agent-supported health
care
U.K

To explore patient andhealthcare professionalviews towards the useof multi-agent computer
systems in their generalpractitioner practice.

Miller et al. (25)A Narrative Studyon the Impact ofInformation andCommunication
Technology on the
Relationship between
Patients and Medical
Learners
CanadaTo explore medical
learners’ perspectives
on Information andCommunication
Technologies (ICTs)
and its impact on therelationship between
them and their patients.

Leung et al. (26)Perceptions ofprofessional attributes
in medicine : aqualitative study inHong Kong
Hong Kong

Study design /methods

Relative
themesFive representative
healthcare
professionals and 11
patients (n = 16)

When rapport and trust
between healthcare
professionals and patients are
established, new technology
can be introduced and readily
accepted by patients ; Trust of
one’s patients may be a greater
asset than technological skills.

In-depth interviews
and analysis oftranscriptions

Technology
and caring
competency

ICT implementation improved
the quality of care by allowing
for rapid access to patient
Five student physicians
information and facilitatingfrom a single hospital
clinical decision-making but
may hinder the patient rapport
building skills of student
physicians.

Technology
and caring
competency

Grounded theory

Qualitative method(Narrative inquiry)
Semi-structured,in-depth interviews.
Thematic analysis
Qualitative method

To explore theperceptions of medical
professionalism in HongKong.

To identify, characterize,
and classify the criteriathat the public uses
to judge the quality ofprimary healthcare(PHC) services in an
African Rural context.

To investigate theBrown-Johnson et al.
concept and practices(28)of ‘clinician presence,’
What is clinician
exploring how physicianspresence? A qualitativeand professionals create
interview study
connections, engage incomparing physician
interpersonal interaction,and non-physician
and build trust withinsights about practices
individuals acrossof human connection
different circumstances
U.S.A.
and contexts
Bahadori et al. (29)
Patients’ andphysicians’ perspectives
and experiences on
the quality of medical
consultations : aqualitative evidence
Iran

Main findings

Qualitative method

Thirty-nine
The image of a professional
participants included
Semi structured
physician as a morally ideal
six medical facultyTechnology
interviews
person, with virtue ethics,
preceptors, six hospitaland patientcommunication skills, attitudes
residents, four medical
centered
Grounded theory wasencompassing holistic care, andinterns, eight nurses,
care
employed for framing
a balance between patient andeight out-patients, andand analyzing thefamily autonomy.
seven medical students.
interviews.

To investigate whether
De Rosis anda patient’s decision
Barsanti (32)
to : 1) use the internet
Patient satisfaction,
for health- related
Quantitative methode-health, and theinformation or 2) shareevolution of theinformation found on
Cross-sectional
patient–generalline with a generalsurvey using thepractitioner
practitioner is affected by
Likert scale
relationship : Evidence the previous relationshipfrom an Italian survey
and experience with
Italy
general practitioners andthe healthcare system.
Haddad et al. (27)
What Does Quality
Mean to Lay
People? Community
Perceptions of Primary
Health Care Services
In Guinea
Republic of Guinea

Participants / samplingand sample size

To explore patients’ andphysicians’ perspectives
and experiences of
the quality of medical
consultations.

1793 participants
Random sampling

A productive relationship withthe family physician and theuse of effective empowerment
strategies can provide more
support for the patient’s healthliteracy and internet use forhealth-related information.

Technology
and patientcenteredcare

180 participants

Patients want to be treated asa whole person rather than thecase and perceive the quality ofhealth cases based on technicalcompetence, interpersonal
skills of healthcare providers,available and adequate
resources, and effectiveness ofcare.

Empathetic
skills

Forty participants
Presence as a purposefulincluded 10 physicians
practice of awareness, focus,
and 30 representatives
and attention with the intent tofrom each non-medical
understand and connect withprofession
individuals / patients.
Convenience sampling

Empathetic
skillsExemplary interpersonal skills
are an important aspect ofphysicians’ clinical competence.
The patients assume that if
the information about theirhealth and illness is describedby physicians in detail, it will
promote the communication
between them.

Empathetic
skills

Qualitative method
Focus group
discussions

Qualitative methodsemi structured
interviews

Qualitative method
Face-to-face or
telephone Interview
Thematic analysis

Forty-eightparticipants
Purposive sampling

The Journal of Medical Investigation Vol. 70 August 2023
Mustika et al. (30)
Unveiling the Hurdles
in Cultivating
Humanistic Physiciansin the Clinical Setting :An Exploratory Study
Indonesia
Berger et al. (31)The patient–physician
relationship : an accountof the physician’s
perspective
IsraelTo explore the process ofteaching humanism andprofessionalism in theclinical setting from theperspectives of clinicalteachers, residents, andmedical students.

To explore and clarify
how physicians perceive
the mutual relationshipthey share with theirpatients.

Qualitative method
Focus group
discussions and indepth interviews
Thematic analysis

Medical clerks,
residents, and juniorand senior clinicalteachers
Maximum variation
sampling

Quantitative method
Descriptive survey
using a semanticscale

291 physicians

they believed that technological intervention can be complementary. Through structured interviews, they determined that whentrust and patient rapport have been established, new technology
are more readily accepted when introduced. Meanwhile, througha narrative study, Miller et al. (25) explored medical learners’
perspectives on Information and Communication Technologies(ICTs) and its impact on the patient- physician relationship.
They found that ICT integration into healthcare allows physicians-in-training rapid access to patient information and facilitates in clinical decision making, however, there were mixed
reviews regarding the ability to maintain the patient-physician
relationship as technological advancements may increase thepsychological distance between physicians and patients and hindering the development of their clinical empathy.

Empathetic Skills

Technology and Patient-Centered CareTwo studies stood out with the theme of the role of technology
in the care of the patient. In the study by De Rosis et al. (32),they investigate what motivates patients to use the internet for
health-related information (e-health) and share it with a generalpractitioner (GP). The use of surveys inquired about the patient’s
satisfaction and experiences with their general practitioners,
the healthcare system, health information and communication
related behaviors. It showed that a younger, more educatedpopulation use the internet for health- related purposes andthat dissatisfaction with the healthcare system leads them to
use the internet more. There was no significant association withinternet use for e-health and patient dissatisfaction with their
GPs ; however, it was noted that their role was important increating a productive relationship with their patients as well as
empowering and directing them to better health literacy practices. Leung et al. (26) sought to explore the qualities patients consider to be ideal or sought- after among the physicians in theirrespective communities, and while their study was not primarily
geared toward technology involvement, their results reveal thatpatients consider technological competency as one of the ideal
physician qualities. Leung et al. (26) conducted interviews andrevealed that the respondents’ image of a professional physician
is a morally ideal person, with virtue ethics, communication
skills, attitudes encompassing holistic care, and provides a balance between patient and family autonomy. It was also notedthat patients who use the internet feel more informed and less“submissive” hence, respondents believe that a physician who
is continually “striving for excellence” in medical technologicaladvancement is a good attribute to have.

311

Humanism is a core featureof medical professionalism
whose attributes include
altruism, a collaborative spirit,knowledgeability, competence,
attentiveness, caring, andcompassion.

CaringCompetency

While physicians believe theirjob performance is the mostsignificant indicator of trust in
the relationship, patients preferinterpersonal relationship with
their physicians and want tobe more informed about theirproblems and be more involvedin the treatment process

Caringcompetency

The theme of physician’s empathetic skills towards patientsis prominent in three studies. In the study of Haddad et al.
(27), they identify the perceptions of quality Primary HealthCare (PHC) services in an African rural community context
through focus group discussions. It revealed that although thecommunity holds the healthcare provider’s technical ability “tocure” important, they are most concerned about having proper
reception and treatment and to be considered as a person witha health problem rather than a case. For the respondents, it inspires courage and the way the physician receives the patient isa source of comfort and helps the patient accept their difficult situation. Similarly, Bahadori et al. (29) sought to explore patients’and physicians’ perspectives and experiences of the quality of
medical consultations in Iran. The study showed that among allother components of quality discussed in their interviews, most
respondents found that the exemplary interpersonal skills are
the most important aspect of the physicians’ clinical competence.
They also find that the clarification of the health problem andclear description of the treatment process are the most important parts of a physician’s visit and patients assume that if theinformation about their health and illness are described byphysicians in detail, it will promote the communication between
them. Brown-Johnson et al. (28) on the other hand explored how“clinician presence” is defined from insights inside and outside
the medical field. Through structured interviews, physicians
and non-medical professionals were asked about the concept ofcreating a connection, being more present, building trust, adjusting strategies for different people, and navigating the environment during interactions with clients and patients, and derived
a definition that “Presence is a purposeful practice of awareness,
focus, and attention with the intent to understand and connect
with individuals/patients.” They found that “presence” is a universal concept that involves intentionality, focus, and attention
to time and physical environment.

Caring Competency
The theme of caring competency or the understanding of
caring competency was observed in two studies. Berger et al.
(31) explored and clarified how physicians perceive a mutual
relationship with their patients. Because social relationships
are complex and not a single dimensional concept, Berger etal. (31) used the multi-dimensional Ganqing-Renqing-Xinren(GRX) scale to explore individual relational constructs andwhen put together, can build a better picture of what is seen
as a quality relationship. They utilized three major relational

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L. Bollos, et al. Physician’s Caring Competency

constructs : Benevolence, representing mutual feelings and emotional attachments, Reciprocity or matching differing viewpoints,
and Trust, implying credibility. Each main concept had subconstructs representing other social qualities such as “Compassion”
under Benevolence and “Careness” under Trust. Through thesemantic scale and semi-structured interviews, the researchers found that the respondent physicians perceived “Trust” as
the most important factor for patient satisfaction, followed by“Reciprocity” and “Benevolence.” Among the sub concepts, thestudy showed that physicians evaluate their patient relationshipbased on their ability to solve the patient’s problems through devotion, serviceability, reliability, and trustworthiness and least likely
through the sub concepts of social interaction and friendship. The
researchers pointed out that “Trust” and “Reciprocity” are thetwo most important factors in explaining the variation in overallpatient satisfaction more than any other aspects in the eyes ofthe physician. This is a contrast from the patients’ viewpoint, as
researchers pointed out that in other studies, the patients stressthe importance of their feelings and emotions in the patient-physician relationship. The quality of communication between thephysician and patient involves assessment of the physician’s
willingness to include a patient in the decision-making process
and to provide a patient with information at the same time balancing it with better social interaction. As a result, a more activerole must be given to the patient, who being well informed by thephysician, can help in the decision-making process.
On the other hand, Mustika et al. (30) explored the process ofteaching humanism and professionalism in a clinical settingfrom the perspectives of clinical teachers, residents, and medical
students. Their respondents studied modules on humanism ina clinical setting and underwent focus group discussions andinterviews to discuss humanism and professionalism. Throughthe discussions, the respondents proposed the attributes of ahumanistic physician to include patient centeredness, altruism,
a collaborative spirit, knowledgeability, competence, attentiveness, caring, and compassion. Meanwhile, the study noted that
hurdles in cultivating humanistic physicians include a lesshumanistic learning climate, negative role models, students’backgrounds, and the differences between clinical teachers andstudents in their perceptions of effective teaching and learning
approaches. The respondents agreed that teaching future physicians these attributes require a nurturing approach and rolemodeling of these attributes. The researchers concluded that although technology is developing rapidly, the need for humanistic
physicians has not diminished.

DISCUSSION
Four themes were revealed as findings of the study : 1) Technology and caring competency, 2) Technology and patient-centered care, 3) Empathetic skills, 4) Caring competency. Thissection expands on them to provide further evidence.

Technology and caring competency
Technology has come a long way and has improved the practiceand delivery of medicine in many aspects, but the age of technological advancements and the information overload of the 21st
century has also brought many challenges, especially for the patient-physician relationship. Competence is developmental, impermanent, and context-dependent (33). Qidwai (34) mentionedthat exhibition of compassion and empathy through attentively
listening to the patient’s complaints, proper eye contact, andappropriate use of nonverbal cues enables the physician to gain
the trust of a patient and build a rapport, which in turn helps
enhance patient adherence to treatment. From the patients’perspective, advancements in information technology have improved their access to information. Therefore, they are not only
better aware of medical conditions and the treatment options
available but are also exposed to a lot of non-evidenced-based
information. Such advancements have made patients more demanding and in need for better explanation, which has also beena contributing factor in taking the focus away from providing
compassion and empathy during consultations. In a relationship,
the mere presence of fear from litigation erodes trust, thereby
making a demonstration of compassion and empathy even morechallenging.
A peek into the evolution of technology use in healthcare
exhibits a dynamic and fascinating sequence of events that
led to the digital health era as we know it, keeping in view the
progress in technology has been exceedingly fast-paced and isincreasingly orienting towards patient-centric principles (35).
Hawk (36) declared that technology is only ever as useful as thevalue it helps us deliver. It is important to encounter new digital
health technology, we should take a step back and assess how
it can help us to deliver better patient-centered care. Artificial
intelligence, for example, clearly has the potential to flag positive
findings on a Computed Tomography examination or an X-ray
and bring them to a radiologist’s attention quicker than can beachieved currently. However, that is not where its real power lies.
Well-designed technology like this also makes a physician’s task
easier by giving them more control over their work and enabling
deeper interactions with their patients and colleagues. The
best technology reduces the time physicians spend on mundane
tasks, simplifies their work, and allows them to focus on themeaningful art of medicine. To realize technology’s potential tohelp us achieve the goal of truly patient-centered care, however,
we need a culture shift within healthcare.
Recent technological advances are enabling a more individualized consultation experience through Telemedicine or Telehealthservices and secure messaging open communication channels
between their physicians, between patients and health professionals, or between similar patients (37-39). Technologies thatengage patients to report their care experience, outcomes, andfollow-up activities empower them to improve the way healthcare
providers deliver care and measure their performance. Together,
these tools can increase transparency, manage expectations, andinstill trust when patients are at their most vulnerable (37).

Technology and patient-centered care
The quality of patient- physician relationship affects healthand recovery from illness, costs, and outcomes of chronic disease by altering the patient’s understanding of their illness andreducing their anxiety ; it is responding to their emotions andallowing them to participate in the decision making (33). Emerging technology helps improve access, efficiency, and quality ofcare by putting the patient in the center of the digital experienceto drive patient empowerment and engagement (40). Advances
in information technology (IT) enable a fundamental redesignof healthcare processes based on the use and integration ofelectronic communication at all levels. New communication technologies can support a transition from institution-centric to patient-centric applications. However, the literature to date on thesubject of patient-centered systems has focused overwhelmingly
on technical feasibility matters (41).
Patient-facing technology has the potential to improve quality
and safety by enabling patients to take a more active role in theircare (37). By increasing the involvement of patients in their own
healthcare, enabling them to proactively avoid health problems
and better manage their conditions, we create a changing patient-centered technology ecosystem.
A previous study (24), the views of physicians and patients

The Journal of Medical Investigation Vol. 70 August 2023
on the use of computer systems during consults, and while bothsides believed that modern technology should never be allowed
to replace face-to-face interaction during patient consultations,they believed that technological intervention can be complementary. The integration of technology into healthcare allows
physicians-in-training rapid access to patient information andfacilitates in clinical decision making but may hinder empathy
development as over reliance on technological advancements
may increase the psychological distance between physicians
and patients and affect their relationship (25). Physicians andphysicians- in -training have access to practice data throughElectronic medical records (EMRs) and can engage in quality
improvement. Innovations in consultations with other specialists, such as “eConsult” and Rapid Access to Consultation
Expertise, are improving access and offering ease for patientsand referring physicians (42). Through proper training and use
of EMRs, patient care can go beyond diagnosis and treatment
discussion and involve appreciating contextual and socioeconomic factors, which can aid in developing trust and influence
decision-making and approaches to management.

Empathetic skills
Empathetic skills inspire courage, and the way the physician
receives the patient is a source of comfort and helps the patient
accept their difficult situation (29). Empathy, sympathy andcompassion also share elements with other forms of pro-social
behavior such as generosity, kindness and patient-centeredness.
Caring involves some degree of identification of a person as ahuman being with the same needs and deserving the same respect as oneself ; this is part of the moral force of empathy (43).
Empathy and compassion are vital components of healthcare
quality ; however, physicians frequently miss the opportunities
for empathy and compassion in patient care. Empathy and compassion are closely related terms, with empathy defined as theability to sense, feel, and understand another’s emotions, andcompassion defined as an emotional response to another’s painor suffering involving an authentic desire to help (44). Physicians
should be able to understand and connect with their patients onan emotional level, expressing genuine care and concern.
The exemplary interpersonal skills are the most important
aspects of the physicians’ clinical competence. Competence ofclarification of the health problem and clear description of thetreatment process are the most important parts of a physician’svisit and patients assume that if the information about theirhealth and illness are described by physicians in detail, it will
promote the communication between them (29).
Brown-Johnson et al. (28) found that “clinician presence” isdefined from insights inside and outside the medical field. The
concept of creating a connection, being more present, building
trust, adjusting strategies for different people, and navigating
the environment during interactions with clients and patients,
and derived a definition that “Presence is a purposeful practiceof awareness, focus, and attention with the intent to understandand connect with individuals/patients.”

Caring competency
Mayeroff (45) mentioned about caring as the antithesis of simply using the other person to satisfy one’s needs ; it is not as an
isolated feeling or momentary relationship, but a process of helping another grow and actualize oneself through mutual trust
and through deepening and qualitative transformation of therelationship. Being benevolent is equated with being motivatedby sympathy, understanding, and generosity. Benevolence, in the
medical education literature, is frequently conceptualized as altruism, a concept, which has been central to the professionalism
movement in medical education. A professional who is humble is313

not arrogant or prideful (46).
Caring is an innate human trait, the “human mode of being,”(47) a part of human nature, and essential to human existence(48). It is a language of relationships, of attitudes and emotions ; a nontechnical, commonsense language of interpersonal
engagement, and less a language of knowledge and facts (49). Although all humans have the potential to care, it is not expressed
uniformly in every individual (50).
The practice of medicine has always seen the physician as
one with a unique range of knowledge and skills who puts themto use in the care of patients. As such, the physician- patientinteraction is paramount and has served as the foundation ofhealthcare delivery---a personal, caring relationship that has
stood the test of time (51). With the and demands of modern
medicine, however, the physician’s ability to deliver humanistic,patient centered care now seems to inadvertently become a lesser
priority in return for adapting to the changes the 21st century
has brought to medical care (51).
The notion of compassion and compassionate care is playing
an increasingly important role in health professional educationand in the delivery of high-quality healthcare. Compassion—defined as noticing the suffering of another and being motivated toalleviate it is an important healthcare characteristic (52). It is a
topic of great interest in recent healthcare research (53) as patients preferred the physician who are more compassionate andprofessional and as having better communication skills (25, 54).

LIMITATIONS AND IMPLICATIONS
Only 9 studies met the criteria established for the systematic
review. Although studies from different countries were highlighted, the study findings may have widened the horizon of thefindings if more articles qualified for the study. For example,
increasing the inclusive years of article publications may havecaptured more articles that met the criteria for inclusion that asa lack of studies to represent the aims that our study wanted toaddress.
The emphasis on technologies skewed the findings to detect
the prioritization of the roles of physicians in their practice.
Although it is understood that technology is advancing in an exponential rate and that technological dependency in healthcare
processes only heightened the reality of healthcare quality as
dependent on technologies. Physicians, therefore, must engage
in the design, development, application, and evaluation of technologies in healthcare, recognizing the necessity of advanced
technologies as a critical to the implementation of interventions
with technologies as priority tools for fostering quality healthcare. However, while patients recognize the role of physicians ina highly technological world, supported by the findings of thisstudy is the appreciation of humanness as the critical quality ofphysicians that patients consider in choosing to whom to entrust
their healthcare. Physicians’ future dependency on technology
is integral to the characteristics of expressing competency as an
expression of caring. As such, being technologically competent isbeing caring.
The authors hope that this study can be used in furthering
active discussion of valuing physician caring practices within
the framework of being technologically competent and caring.
Technological competency and its involvement in patient care
understanding grounded in caring concepts and ethical andmoral attitudes and responses toward patients is vital to attaining human health and well-being. Physicians should adhere to
ethical and moral standards, maintain patient confidentiality,
and act in the best interests of their patients at all times.

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CONCLUSION
This systematic review explored patient understanding, understanding of caring concepts, understanding of technology,
competency to express compassion, appropriate involvement incaring, and ethical and moral attitudes and responses toward
patients. This review has shown that patients look for a physician as someone who considers their emotions and communicateswith them with the intention to empower them to be responsible
for their own healthcare, or their loved ones’ healthcare. For thepatients, to be cared for by their physician means that beyond
their knowledge and expertise, there is an empathetic understanding and expression of compassion, open communication,
and a developed sense of trust with one another. Enhanced
caring competency by physicians today may be directly related
to technology adoption, influencing the physician’s role in adapt
to these changes while maintaining their expressions of humanness, not only to heal but to guide, educate, and appropriately
empower their patients towards attaining their healthcare goals.

CONFLICT OF INTEREST
The authors have no conflict of interest to disclose.

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