VUB thesis exposes power dynamic in doctor-patient relations
The internet as a source of information about health is no panacea for creating patient empowerment. That’s the conclusion reached by Edgard Eeckman in the doctoral thesis he defended at VUB’s Communication Science faculty. He researched the power balance in the doctor-patient relationship and the influence of online and offline information about health, in a study that reveals the power dynamics associated with being ill. Despite patients having more information and knowledge via the internet, the balance remains uneven. Eeckman is therefore calling for an end to this imbalance and for better understanding of patient dependency on current and future care providers, to create a more emancipated approach.
GPs unaware of power imbalance
As well as being a new PhD, Edgard Eeckman is communications manager at UZ Brussel and has long been professionally interested in this subject. “The doctor-patient relationship is a matter of mutual dependence. When someone becomes sick, it can create a dependence that can completely disrupt their life. The patient is dependent on their doctor for a number of ‘resources’, such as information and knowledge about their condition, as well for diagnosis and prescriptions. Uncertainty about an illness or treatment and the assessment of risk or concern by the patient can increase the degree of dependence. This may be accompanied by loss of control and autonomy, which can have a negative effect on the patient’s wellbeing and may cause resistance. The doctor, in turn, is also dependent on the patient - for example, for their income - but they still hold the balance of power. This imbalance remains, despite the fact that the internet can be a useful source of information for the patient, for example to help them better communicate with the doctor and increase their influence during a consultation,” Eeckman says.
“Medical experts need to be aware of this, and of the dependence of their patients. Through a better understanding of each individual patient, doctors can reduce any resistance and increase the intrinsic motivation to follow treatment correctly. That can benefit the healing process, the treatment, the relationship with the care providers as well as the health of the patient and the healthcare system.”
The internet is no panacea
Eeckman says it’s also the task of a doctor to ensure that someone who is sick maintains as much feeling of control as possible, to the extent to which the patient wishes. Communication plays an important role in this. The internet can help a patient find the necessary information and knowledge to better understand what will happen to them and when. Without this understanding, the process simply happens to them and they experience a feeling of loss of control. Control, or the feeling of control, over health and healthcare is known as patient empowerment. This is a valuable concept, but health information via the internet is not the way to achieve it.
Eeckman’s analysis shows that the internet has the potential to reduce the information and knowledge gap between doctor and patient, but not to remove it altogether. Despite the information available online, the power balance between doctor and patient remains asymmetrical.
Towards a more emancipated approach to the patient
“The challenge with the doctor-patient relationship is to avoid a power dynamic, because it is contrary to the trust that characterises the relationship and is in the interest of both the patient and the GP. Informing a patient is not enough; the doctor must let go of some control. The result is an equal and confidential doctor-patient relationship with mutual respect for each other’s specificities, knowledge and skills. Insight into the patient’s dependence can contribute to a more conscious drive towards a more emancipated approach to the patient. This conceptual framework can stimulate the critical self-reflection of current and future care providers, including in nursing training,” says Eeckman.
Edgard Eeckman carried out a wide qualitative and quantitative study using an online survey with 3,053 respondents, and by analysing 24 video recordings of patient consultations, follow-up interviews, focus groups and discussion groups. He focused on Dutch-speaking Belgian adult patients on one side and doctors on the other side.
Edgard Eeckman biography
Edgard Eeckman gained his doctorate in media and communication studies at VUB on 10 October 2018, with his thesis “Power to the Patient? Studying the power balance between patient and GP in relation to Web health information”. He is 61 and has been a full-time communications manager at UZ Brussel since 2005. In 2016, with Marc Noppen, he published the parody of healthcare “De goden lossen het op” and in 2015 he and Petra Van San published the book “Communicatie Troef: Effective communication in and by healthcare organisations”. He is also a research assistant at CEMESO, VUB’s Research Centre for Culture, Emancipation, Media and Society.
Edgard Eeckman: 0475 96 00 67