Paternalistic practice within the patient-provider relationship could be explain low patient participation in electronic health (eHealth) services, such as patient-accessible electronic health records (EHRs). Findings were published in the Journal of Medical Internet Research.

“Literature of at least two decades suggests an overall agreement that the paternalistic approach in health care is inappropriate, and a collaborative process with patients should be adopted,” wrote first author Christiane Grünloh, MSc, and colleagues. “Although the physicians in this study stated that they, in principle, were in favor of patient participation, the analysis found little support in their descriptions of their daily practice that participation is actualized.”

In this study, researchers aimed to evaluate the physician’s perspective on patient participation in regard to their patient-accessible EHR to identify its effect on patients and providers. A total of 12 interviews with physicians of different fields were conducted to provide insight into the physicians’ perceptions of EHRs, roles in the doctor-patient relationship and limits of involvement.

Physicians often viewed themselves as the authoritative figure taking responsibility within the relationship.

“As seen from the results, paternalistic practices are still present, even if professionals might not be aware of this. This can create a conflict between patients who strive to become more informed and their questions being interpreted as signs of critique and mistrust toward the physician,” concluded Grünloh and colleagues. “We thus believe that the full potential of PAEHRs is not reached yet and argue that the concept of patient empowerment is problematic as it triggers an interpretation of “power” in health care as a zero-sum, which is not helpful for the maintenance of the relationship between the actors.”