Turning the gaze: Digital patient feedback and the silent pathology of the NHS.

Catherine M Montgomery,Kamal Mahtani,Anne‐Marie Boylan,John Powell

doi:10.1111/1467-9566.13419

Catherine M Montgomery, Kamal Mahtani + Show 2 more

Open Access

https://doi.org/10.1111/1467-9566.13419

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Abstract

Online review and rating sites, where patients can leave feedback on their experience of the health-care encounter, are becoming an increasing feature of primary care in the NHS. Previous research has analysed how digital surveillance is re-shaping the clinical gaze, as health-care professionals are subject to increased public monitoring. Here, we draw on an empirical study of 41 GP practice staff to show how the gaze is turning, not simply from the patient to the health-care provider, but additionally to the body politic of the NHS. Drawing on focus group and interview data conducted in five UK practices, we show how discourses of online reviews and ratings are producing new professional subjectivities among health-care professionals and the extent to which the gaze extends not only to individual health-care interactions but to the health-care service writ large. We identify three counter-discourses characterising the evolving ways in which online reviews and ratings are creating new subjects in primary care practices: victimhood, prosumption versus traditional values and taking control. We show how the ways in which staff speak about online feedback are patterned by the social environment in which they work and the constraints of the NHS they encounter on a day-to-day basis.

Highlights

The rise of consumerism within health care has long been a subject of critical analysis within sociological research, as has more recently the role of patient experience narratives in contributing to this (Lupton, 1997a, 2014)
We describe a pervasive feature of the accounts offered by primary care staff in this study, namely an acute negative response to online patient feedback
In describing the counter-discourses above, we have shown that rather than seeing online patient feedback as a straightforward representation of patients’ experiences of receiving care, GP practice staff mobilise it as a way to talk about and make sense of the conditions in which they work

Summary

Introduction

The rise of consumerism within health care has long been a subject of critical analysis within sociological research, as has more recently the role of patient experience narratives in contributing to this (Lupton, 1997a, 2014). Within these analyses, the changing nature of the doctor– patient relationship has come to the fore, variously focussing on the ascendancy of patient-/ person-centred care (Gothill & Armstrong, 1999; May et al, 2006) and the declining authority and professional status of doctors (Armstrong, 1990; Lupton, 1997b). As new digital tools come to feature ever more prominently in health service provision, the figure of the healthcare consumer is morphing into the ‘digital health citizen’ (Powell & Deetjen, 2019). While an extensive body of work considers the ways in which patient subjectivities are changing with the advent of digital health and its extended capacities for surveillance (Adams et al, 2017; Dubbeld, 2006; Erikainen et al, 2019; Lupton, 2012), the connection between surveillance and subjectification as it relates to the healthcare provider has not been made

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