The Transformation of the Patient-Physician Relationship in Telemedicine: Sociological Approach in Dermatology

In 1999, the inaugural editorial of the Journal of Medical Internet Research underscored the imperative to evaluate the patient-physician 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 closeness between physicians and patients. Others feared these technologies signaled a degradation of interpersonal connections and a dehumanization of health care experiences.

Reflecting on years of developments, we consider this an opportune moment to reassess transformations in patient-physician interactions, in which notions of distance and proximity are redefined in some unexpected ways.

In this paper, we intend to focus on teleconsultation and tele-expertise, the two most commonly used services in our field, dermatology. 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 3 core skill sets among participants: technical, civic, and contract management. In medicine, these translate to the clinical, social, and contractual aspects of care. Telemedicine programs introduce significant shifts and adaptations across these dimensions.

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 is not 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 lead to reification, that is, turning human patients into objects to serve researchers and physicians, and although extensive literature suggests that physicians develop various strategies to mitigate this, other studies indicate an increased risk of reification 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.

Through this analysis of the three components of the service relationship as defined by Joseph, we have highlighted the profound changes affecting the physician-patient relationship in the context of telemedicine. Dehumanization is an inherent risk in any medical health care 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 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 health care interactions.