The Doctor-Patient Relationship in Telemedicine: The State of Play 25 Years On. From a Dermatology Perspective. (Preprint)
Authors: Démoulins Edmond , Trupia Dilara , Martin Ludovic , Mathieu-Fritz Alexandre 
Published: July 2024

BACKGROUND

In 1999, the inaugural editorial of JMIR underscored the imperative to evaluate the doctor-patient relationship amid the advent of Internet-driven medical practices. Even at that nascent stage, views diverged sharply. Some anticipated that novel communication technologies would enhance the closeness between doctors and patients. Others feared these technologies signaled a degradation of interpersonal connections and a dehumanization of healthcare experiences. Reflecting on years of developments, it's opportune to reassess the transformations in doctor-patient interactions. in which notions of distance and proximity are redefined in some unexpected ways

OBJECTIVE

In the present article, we intend to focus on teleconsultation and tele-expertise, the two most commonly used services in our field of dermatology.

METHODS

To navigate these changes, a sociological perspective inspired by Isaac Joseph's theoretical framework has been adopted. Joseph posits that service-oriented relationships depend on three core skill sets among participants: technical, civic, and contract management skills. In medicine, these translate to the clinical, social, and contractual aspects of care. Telemedicine programs introduce significant shifts and adaptations across these dimensions.

RESULTS

A primary challenge in telemedicine is the absence of comprehensive sensory information, a crucial component of traditional medical assessments. This article discusses how such technical alterations impact medical practice and necessitate a redistribution of roles. Telemedicine isn't merely about adapting existing technical skills; it also demands new competencies, often referred to as "invisible work," to make telemedicine work. Beyond its clinical dimensions, the therapeutic relationship is inherently social. It involves sending signals that confer respect and recognition of the other as a "person." A common concern is that telemedicine might objectify patients, although extensive literature suggests that physicians develop various strategies to mitigate these perceived constraints and risks. Conversely, other studies indicate an increased risk of reification—the treatment of people as objects—in constrained contexts. Contract management skills consist of the parties involved reaching an agreement on the purpose of the service-related relationship and its practical applications. In telemedicine, this may involve reminding the patient that not everything can be done remotely.

CONCLUSIONS

To conclude, the issue of dehumanization in the doctor-patient relationship has been a concern in telemedicine for the past 25 years. And yet, this is an inherent risk in any medical healthcare partnership regardless of whether patient care is delivered face-to-face or at a distance. While some studies have clearly documented the dehumanizing tendency of some telemedicine practices, telemedicine itself alone is neither reifying nor dehumanizing. The organizational arrangements, the context of work activities, the modalities of use in situ and the types of technological devices used are all contributing factors in defining the level of humanization in remote healthcare interactions.