Exploring doctors’ perceptions of digital health’s impact on the patient-doctor relationship in Singapore’s primary healthcare setting: A Qualitative Study (Preprint)

Abstract

Digital health has become essential for effective clinical practice. However, successful adoption of digital health is dependent upon the strength of the patient-doctor relationship. The patient-doctor relationship shapes the quality of care and impacts healthcare outcomes, especially in primary care. However, impact of the increasing use of digital health on patient-doctor relationship is uncertain.

As no studies have explored the primary care doctors’ experiences with digital health, we aim to explore the types of digital health primary care doctors use and understand its impact on the pa-tient-doctor relationship from their perspective.

This exploratory qualitative descriptive study used individual in-depth interviews guided by a semi-structured topic guide. We purposively sampled doctors from six general primary care clinics in Singapore and used thematic analysis to identify emergent themes.

We conducted twelve interviews. The study found that primary care doctors in Singapore had minimal exposure to digital health beyond the scope of institutional implementation. The three key themes which emerged were (1) evolving roles of both doctors and patients, (2) impact on trust, knowledge acquisition and longitudinal care, and (3) adoption and usage factors of digital health impacting patient-doctor relationship. The adoption and usage factors comprised of ‘social and personal’, ‘technical and material’ and ‘organisation and policy’ factors.

The study identified that while primary care doctors had similar exposure to digital health and held mostly positive views on adopting digital health in improving patient-doctor relationship, they were concerned that digital health might erode trust, hinder proper knowledge acquisition and reduce humanistic interaction. These concerns called for a nuanced approach to ensure digital health would not compromise the patient-doctor relationship. This could be achieved by ensuring that doctors possess the necessary skills, knowledge and positive attitude, while healthcare organisations would provide robust IT capabilities and support. We recommend that education be refined and govern-ment policies on digital health adoption and usage be revised to align with the goal of strengthening the patient-doctor relationship.