How does the use of digital consulting change the meaning of being a patient and/or a health professional? Lessons from the Long-term Conditions Young People Networked Communication study.

BACKGROUND: While studies have examined the impact of digital communication technology on healthcare, there is little exploration of how new models of digital care change the roles and identities of the health professional and patient. The purpose of the current study is to generate multidisciplinary reflections and questions around the use of digital consulting and the way it changes the meaning of being a patient and/or a health professional. METHOD: We used a large pre-existing qualitative dataset from the Long-term Conditions Young People Networked Communication (LYNC) study which involved interviews with healthcare professionals and a group of 16-24 years patients with long-term physical and mental health conditions. We conducted a three-stage mixed methods analysis. First, using a small sample of interview data from the LYNC study, we identified three key themes to explore in the data and relevant academic literature. Second, in small groups we conducted secondary analysis of samples of patient and health professional LYNC interview data. Third, we ran a series of rapid evidence reviews. FINDINGS: We identified three key themes: workload/flow, impact of increased access to healthcare and vulnerabilities. Both health professionals and patients were 'on duty' in their role more often. Increased access to healthcare introduced more responsibilities to both patients and health professionals. Traditional concepts in medical ethics, confidentiality, empathy, empowerment/power, efficiency and mutual responsibilities are reframed in the context of digital consulting. CONCLUSIONS: Our collaboration identified conflicts and constraints in the construction of digital patients and digital clinicians. There is evidence that digital technologies change the nature of a medical consultation and with it the identities and the roles of clinicians and patients which, in turn, calls for a redefinition of traditional concepts of medical ethics. Overall, digital consulting has the potential to significantly reduce costs while maintaining or improving patient care and clinical outcomes. Timely study of digital engagement in the National Health Service is a matter of critical importance.

A Historical View on Health Care: A New View on Austerity?

It is an axiom of contemporary conversations about austerity and health care that the relationship between the two is essentially direct. Cutting funds damages health care systems and hurts the health of individuals who rely on them. Though this premise has provoked necessary discussion about global politics, the global economy and their impact on individual well-being, it is nonetheless intrinsically problematic. Assigning health and health care as objects of austerity not only obscures the complexity of health care systems and the opacity of health's definitional borders, but also misunderstands austerity, its manifestations and its significance. The ambition of this essay is to bring health care back into the debate, in order to establish the greater dynamism of the contemporary austerity and health care relationship. This historical reconstruction will challenge the significance of our current situating of austerity as health care's bogeyman, press for a reconsideration of our contemporary definitions of the key factors involved here (health, health care and austerity) and finally conclude with some thoughts on how we might more productively approach the problem of health now.

'Items for criticism (not in sequence)': Joseph DeLee, Pare Lorentz and The Fight for Life (1940).

In the late 1920s, the American obstetrician Joseph DeLee brought the motion-picture camera into the birth room. Following that era's trend of adapting industrial efficiency practices for medical environments, DeLee's films give spectacular and unexpected expression to the engineering concept of 'streamlining'. Accomplishing what more tangible obstetric streamlining practices had failed to, DeLee's cameras, and his post-production manipulation, shifted birth from messy and dangerous to rationalized, efficient, death-defying. This was film as an active and effective medical tool. Years later, the documentarian Pare Lorentz produced and wrote his own birth film, The Fight for Life (1940). The documentary subject of the film was DeLee himself, and the film was set in his hospitals, on the same maternity 'sets' that had once showcased film's remarkable streamlining capacity to give and keep life. Yet relatively little of DeLee was retained in the film's content, resulting in a showdown that, by way of contrast, further articulated DeLee's understanding of film's medical powers and, in so doing, hinted at a more dynamic moment in the history of medicine while speaking also to the process by which that understanding ceased to be historically legible.

The Autobiographical Shoulder of Ernest Amory Codman: Crafting Medical Meaning in the Twentieth Century.

This essay offers a reconsideration of the historical significance of Ernest Amory Codman's autobiographical preface to his 1934 text The Shoulder, Rupture of the Supraspinatus Tendon and Other Lesions on or about the Subacromial Bursa and its reception, in its own time and at the end of the twentieth century. It concentrates on the aesthetics of identity and the ways in which these are woven into the political, professional, and cultural contexts of these two periods. It argues finally that Codman's style of life writing, both in the autobiography and throughout his texts, served as an important historical actor that more generally demonstrates the possibilities in approaching the history of medicine from aesthetic angles. In this way, it also calls for a tabling of the more canonical concerns about the American medical profession in the twentieth century in order to focus more empirically on questions concerning the development of medical meaning more broadly conceived.