Professional decision making with digitalisation of patient contacts in a medical advice setting: a qualitative study of a pilot project with a chat programme in Sweden

BMJ Open. 2021 Dec 2;11(12):e054103. doi: 10.1136/bmjopen-2021-054103.

Abstract

Objectives: Patient e-services are increasingly launched globally to make healthcare more efficient and digitalised. One area that is digitalised is medical advice, where patients asynchronously chat with nurses and physicians, with patients having filled in a form with predefined questions before the chat. This study aimed to explore how occupational professionalism and the possibility of professional judgement are affected when clinical patient contact is digitalised. The study's overall question concerns whether and how the scope of the healthcare staff's professional judgement and occupational professionalism are affected by digitalisation.

Design and setting: A qualitative study of healthcare professionals working in a pilot project with a chat programme for patients in a medical advice setting in Sweden.

Participants and analysis: Contextual inquiries and 17 interviews with nurses (n=9) and physicians (n=8). The interviews were thematically analysed. The analysis was inductive and based on theories of decision making.

Results: Three themes emerged: (1) Predefined questions to patients not tailored for healthcare professionals' work, (2) reduced trust in written communication and (3) reduced opportunity to obtain information through chat communication.

Conclusions: The results indicate that asynchronous chat with patients might reduce the opportunity for nurses and physicians to obtain and use professional knowledge and discretionary decision making. Furthermore, the system's design increases uncertainty in assessments and decision making, which reduces the range of occupational professionalism.

Keywords: health informatics; human resource management; information technology; organisation of health services; public health; telemedicine.