Digital Health Communications. Группа авторов
Instagram, etc.), the medical profession must face and deny a multitude of fake news stories. Open controversies of a new kind, such as the authorization (by a scientific fringe and a bureaucracy shaken in the temporality of their protocols) of the administration of a treatment not yet approved, are an opportunity for the diffusion in the public space of points of view with no other form of legitimization other than the recognition acquired on the Internet of those who share them.
The broadcasting and digital echo of the debate are part of the new creation of public opinion [CHA 90], which is quick to question any authorized speech. While this phenomenon is not exclusive to the health field, we do see the emergence of lay or amateur expertise [FLI 10]. And what about technological surveillance logics aimed at identifying and preventing, via smartphones, the physical contact of people diagnosed positive for Covid-19 through mobile geolocation applications?
Beyond the “general public” dimension of digital communication in healthcare, medical teams benefit from the creation of true communities of practice [COH 06] that enable them to share crucial knowledge about the disease. However, they are also confronted with the limitations of tools that cannot replace physical interactions, for example, during transmissions between night and day shifts in the hospital environment [GRO 98].
The same is true for local medicine. Although telemedicine allows private practitioners to maintain contact with patients with symptoms of Covid-19, particularly in certain territories already marked by the medical desert syndrome, these healthcare professionals nonetheless miss the accuracy of the diagnosis made possible by the traditional face-to-face consultation.
These healthcare professionals are also faced with the rediscovery of a digital divide that was thought to have been reduced by the quality of broadband telecom services, but these services are in fact still unevenly distributed across territories.
As a result, some rural areas, which have not yet been beneficiaries of fiber optic networks, find themselves penalized since videoconferencing services, necessary for remote consultation, require a very high data rate only possible with the installation of fiber.
P.1. The French and Quebec health systems as a heuristic context for analysis
As we will have understood, the spread of Covid-19 and its consequences, medical, economic, social and cultural, constitutes a pivotal moment in contemporary health information and communication issues in a digital context. It brings to the forefront both the consequences of a massive use of digital tools in medical practice and the no less central issues of increasingly digitalized interactions between patients and caregivers, between patients, and between caregivers.
The scope of health communication is therefore very broad. We can try to circumscribe it provisionally in a general definition. From our point of view, health communication encompasses all of the processes involved in creating, disseminating, sharing and evaluating information on health topics that are likely to affect the health of the public, or that are communicated in the organizational context of institutions or professional networks dedicated to health. Digital health communication concerns all health communication phenomena conveyed by sociotechnical information and communication dispositives (SICDs).
It is clear that in 2020, it is deeply illusory to want to dissociate “digital health communication” from a hypothetical “non-digital health communication”. As in all fields of human activity, digital communication is embedded in all forms of interaction and relationships. Nevertheless, it still seems relevant to us to question the specifically digital part of health info-communication issues. Quite simply because we have not yet exhausted our understanding of the consequences of digitization on all of our activities, and particularly in the health sector.
The experience of the Covid-19 health crisis makes this analytical process all the more important since a multitude of supporting discourses are opposed to a no less significant volume of analyses pointing out all the risks inherent in the socio-technical ecosystem. On the one hand, we can identify prescription discourses aimed at the rapid adoption of digital tools facilitating access to information, reducing opportunities for interaction with caregivers or other patients ready to discuss their care pathway, enabling remote medical monitoring or improving the coordination of the action of medical teams [DUP 10, VAL 15]. On the other hand, we can also observe alarmist points of view that indicate the harmful effects of the massive implementation of digital information and communication technologies (DICTs) in terms of the remote monitoring of inhabitants, the development of teleworking that alienates people under the guise of economic optimization, or the future dehumanization of patient care by seeking to digitally compensate for the problem of territorial inequalities in access to care.
The positioning of information and communication sciences in the concert of human and social sciences must allow for relevant, current and heuristic clarifications of approaches to understanding the mechanisms of insertion and, we should also say, of the social insemination of ICT.
Our perspective is anti-deterministic. However, it can well be about the very mechanisms of a deterministic technological thinking at work among critics and promoters of an ever more digital society, increasing or even preserving humanity for some, enslaving it for others. It is at the heart of this tension that the info-communication processes are deployed, between cure and care, which we propose to study in this book. The research carried out for more than 30 years on the specific stakes of the social insertion of DICTs has made it possible to build an active community of researchers who, between the sociology of uses [JAU 11, JOU 00, PER 89], the digital communication of organizations [DUR 09, LEP 02], the new creative and digital industries [BOU 12, MIE 17], the semiotics or semiology of the digital world [BAD 15, BON 13, PIG 09], design [CAR 17b, LEL 02], changes in public debate, the digital mediation of knowledge [JAC 02, MOE 10, PER 12, PER 14] and the challenges of electronic socialization [GAL 05, PRO 00, PRO 06], provide a solid foundation for the identification, analysis and understanding of a digital health society in the making.
The scientific work that gives substance to this approach is located territorially. We question identifiable institutional contexts that, though they are limited to France and Quebec, bring to the forefront issues which, we believe, common to all communities involved in the digitization of health care. However, the health culture is not the same in Canada and France. For example, it is very much marked by the centralizing power of the State in France, and it seems much more imbued with the commitment of healthcare actors in Quebec. The various works presented here will be concerned with showing this context, which seems to us to be rich in similarities, as well as in differences, if only because of their distinct reactions to the logic of the new public management [DEG 14].
Indeed, the idea that corporate management can be applied to all forms of organizations, especially those focused on the common good, such as health organizations, now conditions all activities in the health sector. The logic of efficiency, whose limits are becoming apparent in this period of Covid-19 crisis (e.g. a lack of beds in intensive care units because they are not useful in normal times, a lack of nursing staff because of a decrease in the number of personnel owing to the neoliberal dogma of cost reduction, and a lack of masks, a consequence of the precepts of lean management [BOU 15b], etc.), is predominant in all countries, but with forms of acceptance or resistance that may prove to be different.
It is, of course, the case with regard to the French and Quebec cultural contexts which we focus on here. Similarly, for these two territories, acceptance and resistance to the digitization of care may be similar in many respects, but more specific in others. It seems certain to us, however, that Quebec society and French society can show some form of relevance to reflections on a global health system in crisis; this is a health system in which the care actors, in a form of consensus, question liberal strategic-economic precepts that until now seemed to be the fruit of “vulgar” managerial common sense, despite the exhaustion and repeated alerts of the care workers, particularly in France where half of the emergency services were on strike in September 2019 to demand more resources.
P.2. Information and communication sciences: a theoretical corpus and methodologies for understanding digital communication in healthcare