2.3 Information sharing in a multidisciplinary arena
2.3.1 The Paternalistic Approach: Past practice still endorsed by power driven
Formerly, the decision making process was strictly reserved for the healthcare professionals, since they had a qualification and acquired expert knowledge through education, therefore the healthcare professional knew best. Consequently, for this reason patients left it to the qualified professional, to gather patient-specific information from them, analyse the information and then reach finalising decisions without receiving informed consent from the patient (Kon, 2010).This situation is all too familiar in the public sector, where the patient is powerless to challenge the doctor, the autonomy of the patient is restricted, so the patient will give up all power for the doctor to make the final decisions on behalf of the patient.Nowadays, this approach is not realistic for the doctor to have the information and take full control of the interaction with the patient, without involving the patient. Patient dissatisfaction is brought about by poor or breakdown of communication levels in this relationship (Fong and Longnecker, 2010).Another model which imitated the paternalistic approach, was a Disease focused model. In this model, the conditions of this relationship were based on the fact that the doctor was the expert, who possessed all the information and a strategy for the treatment plan. All conclusive decisions were taken by the doctor on behalf of and in the best interest of the patient (Rowe and Moodley, 2013).
The doctor cannot have divided loyalty or conflicted interest for that matter;
otherwise this relationship will be jeopardized. A term that was used to describe the
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imbalance of information in this relationship is called, Asymmetries of Information.
This term was created to describe how healthcare professionals and patients can hold an uneven distribution of information. The drawbacks introduced by Asymmetries of Information discourage openness, reliable free information and conversely encourages the manifestation of corruption, misuse, over claiming and overcharging by healthcare professionals (Rispel, De Jager and Fonn, 2015).
In a Consumerist model, the patient is referred to as a consumer of healthcare or healthcare consumer, vice versa. In this model, there is a shift from professional ethics to commercialized business ethics (both these have different ethical principles). The patient is treated like a commodity or a product and the doctor is referred to as the healthcare provider. The healthcare provider’s main concern is to build a business empire and attracting as many healthcare consumers as possible (Rispel, De Jagerand Fonn, 2015). Nortje and Hoffman (2016), describe the consumerist model as one that is practiced internationally in the growing private healthcare sector. Similarly, South Africa is increasingly adopting the consumerist model, which may pose detrimental challenges in the quality of healthcare, where healthcare professionals will be focused on making money, become less attentive to the needs of their patients and basically incompetent practitioners. The shift from healthcare professional to healthcare provider will mean that the care ethics of doctors are misaligned with those of the patient (Nortje and Hoffman, 2016).
In an Era where information technology has taken over, where information is freely assessed and available, the patient is the one who has the power to make definitive choices, regarding their health. It is crucial that concerned parties obtain patient informed consent, before any go-ahead is given (Wilson, 2017). A Doctor-Patient relationship mirrors that of a teacher-scholar relationship, which rides on trust, honesty, transparency and quality of care(Limberg,Sundin and Talja, 2012).The widespread use of social media connections, such as the internet, Facebook, Instagram, Twitter, has allowed access to an abundance of information, freely allowing the patient to gain clearer perspective of any medical issues. Patients will consult with a medical practitioner or a specialist with a list of questions pertaining to their disease state and recommended treatment plan, from the information derived from the internet. Nortje and Hoffman (2016) add that, there are a rising number of patients who have sound knowledge of patient rights and the responsibility of the
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healthcare professional. The researchers affirm that this can be attributed to influence of mass media (print and electronic), which allows the patient to confidently present the doctor with educated questions.
However, it is all too good to say that patients are proactive when it comes to their health information, but what happens when this medical information isn’t critically analyzed or peer-reviewed by a doctor or a disease management team? It can be said that, too much unfiltered information, coming from unworthy sources, with no medical accreditation may result in self-management and self-treatment possibilities (OECD, 2017). This will lead to delayed disease management and progression of the disease state, which may lead to death. Another, casual effect of uncertainty in the healthcare industry can be attributed to the many role players who possess different information and knowledge (OECD, 2017). The greatest barrier to sharing of information is that some stakeholders are resistant to the adoption of information technology. The roles players involved in the care of the patient such as (Fichman, Kohli and Krishnan, 2011):
1. Healthcare providers
• different professional disciplines, training and experience
• have specialized information and knowledge 2. Healthcare consumers(patients)
• personnel characteristics, disease states and treatment plans
• knowledge is limited towards the doctor and the type of service required
3. Medical service delivery and medical procedures.
4. Pharmaceutical companies
• Drug advances and drug knowledge
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2.3.2 The Patient-Cantered Approach: Putting the patient in the middle of