Why the relationship between clinicians and patients should Hmatter to engineers

Addressing people’s feelings about wearing medical devices

In the University of York’s Equitable Technology Lab (ETL), we are interested in equity of medical devices. We have been working with patients to explore attitudes and views of CGM devices. Although at an early stage, our work with Type 1 diabetes (T1D) patients in Sheffield and Scarborough has already highlighted that age and gender-related factors affect how patients use and feel about CGM devices. For example, young women express apprehension over the wearability of their devices in public while elderly patients have reported difficulties navigating and managing data and digital interfaces.

Cognitive and physical factors, such as neurodiversity and hearing issues, can also make devices difficult to use and can contribute to experiences of inequity. This work, together with current literature, suggests that inclusive participation that recognises intersecting social categories such as gender and race can actively address such unintended consequences and inequities in healthcare technologies. Inclusive participation will ensure that otherwise marginalised groups are adequately and meaningfully involved in developing healthcare technologies that cater for their needs.

However, this is not the whole picture. To fully address inequity in medical devices, we need a more nuanced appreciation of how technologies shape and are shaped by the context in which they are deployed and used. For example, at ETL our work has started to show that the way CGM technologies are used can mould the relationship between clinician and patient. This arises from how the data, information, and decision support systems associated with CGM devices are largely geared towards the needs of clinicians rather than patients. In some cases, this can lead to a problematic distinction between the ‘expert’ (clinician) and ‘nonexpert’ (patient), which can undermine relationships with healthcare professionals. 

Meeting the needs of patients and clinicians 

The inequities and unintended outcomes that patients often experience when using medical devices are frequently informed by a disconnect between the needs of clinicians and those of patients. A key driver here is that a scientific understanding of health and disease frames the data gathering and interpretation by medical technologies. However, this tends to overlook the contextual differences that are important in how patients experience and respond to their condition and to healthcare interventions. Put simply, patients do not think about their disease in the same way that clinicians do – or indeed the way other patients do. 

This problem is increasing in scale and complexity. Within UK healthcare, the notion of patient self-management supported by technological innovation is becoming increasingly dominant as a viable, cost-effective solution for reducing the NHS’s operational burden. This has driven new relations between patients and health professionals, which today includes clinicians, consultants, nurses, and local patient advocates. These relationships are increasingly mediated by medical devices and digital systems. 

Inevitably, technologies (such as CGM) inform how patients are understood by clinicians and healthcare practitioners. And these technologies also change how healthcare professionals interact with patients and the terms on which they seek to regulate their behaviour. Our findings are revealing how technologies are unintentionally altering these relations, removing the opportunity to appreciate the patient’s own views on their condition or particular circumstances.