By Dr. Nicole Gross, Change Team, ARCH

Imagine the following two scenarios. First, you are a fully digitalised patient. You see the online doctor every so often, you have wearable technology devices that track your every move, and you are fully plugged into a database that holds your medical records and makes sense of the continuous stream of data which you produce. But you are lonely and feel like no one truly cares about you. Second, you are empowered, fully self-tracking and managing your healthcare. You are in charge and only choose to commission your healthcare provider to validate what your technology has already told you. But you forgot to monitor symptoms or miss vital clues, and you become seriously ill.

21st Century PatientBoth scenarios speak to the question of what digital healthcare and technology does to the patient, his/her behaviours and interactions with others. As we are getting more interested and perhaps reliant on integrating technology into the delivery of healthcare, we have developed a finer understanding of its co-constitutive relationships. On one side, we construct and develop the technology which we hope will make our healthcare more patient-centred, effective and cost-competitive. On the other side, as users of technology, we are becoming what the technology allows us to become – a new type of patient. Illustratively, technologies like the fitbit, jawbone or the Nike fuelband allow us to track our every move and heart rate. My fitness pal allows us to monitor our calories in and calories out. Electronic health records give us a 360 degree view of our health and big data enables complex predictictions of what might happen to us. With these tools, we become digitalised and connected patients. However, at the same time, these technology tools set up an expectation and channel our behaviours. Now you think about how many steps you should take, how you want to manage your data or how you engage with your healthcare provider. All of a sudden, we are deeply entangled in a web of technology and human agency, a complex web which the digital patient patients needs to navigate in order to optimise their health and well-being journey.

But how is a patient expected to behave in a digital world, in which s/he needs to express their individual needs whilst ensuring that the logics of digital healthcare still hold up to scrutiny. How do patients deal with the tensions of patient empowerment and self-management whilst being asked to strictly follow the rules of an medication adherence app? Through online programs and apps, patients are being asked to radically change their diet and lifestyle e.g. smoking, yet predictive data analytics relies on a lack of behaviour change in order to make accurate predictions. What if patients successfully self-manage their chronic conditions at the expense of social isolation and mental health?

As fictions and expectations in digital healthcare become realities, are we asking patients to take on too much? Can they be successful producers and consumers at the same time? Can we ask them to be both, the person who needs care and the managers of healthcare? Can we ask them to self-direct and yet listen to what healthcare professional have to say? Are we asking our patients to take on too many roles, identities and obligations at the same time? And, more importantly, how do we construct future technologies to give patients the opportunity to take on such new roles, identities and obligations?

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