Changes in the Relationship between Medical Professionals Mediated by an Information Tool: An Ethnography of Team Medicine in Japan
Authors: Hiromi Yamaguchi, Yasunobu Ito
Abstract: Comparing the percentage of the total population aged 65 and over in 2021, Japan (29.1%) is the world's highest super-aged society. It has been predicted for some time that the existing healthcare system would not be able to cope with the increasing demand for healthcare. One of the government's proposals to restructure the healthcare system is to make greater use of team medicine.The purpose of this paper is to clarify what has changed through team medicine mediated by information tools. The study site was a medium-sized hospital in a regional city in Japan. The research method used was ethnography with a focus on participant observation. The study period was eight years, from 2012 to 2020. One of the authors conducted the investigation while working at the hospital as a hospital staff. In the 2012 revision of medical fees, the Ministry of Health, Labor and Welfare (MHLW) added the new item of "guidance and management for prevention of dialysis (through team medicine)" to prevent serious complications in diabetic patients.The new reimbursement system only set out the conditions for calculation and left the operation of the system to the hospitals themselves. Hospitals were initially confused, and medical professionals did not know what to do. However, the introduction of the MAP information tool, which visualizes and lists the patients' treatment status, has made it possible for the health professionals to work proactively. Through the mediation of MAP, inadequate treatment of patients (e.g., lack of necessary tests, inadequate selection of appropriate drugs, etc.) became clear. Under such circumstances, not only nurses and pharmacists but also medical secretaries have been transformed into people who are relied upon by doctors. Such a change was born from their attitude that they did not accept team medicine, which was mainly based on hierarchy and division of labor among medical professionals, and that they were willing to take on the work of other professions. In other words, each specialized profession filled in the gaps in patient care that tended to arise by overlapping their respective duties. In addition, the relationship between doctors and other professionals has changed from a hierarchical relationship to a mutual relationship in which problems are raised.In conclusion, it was found that the mediation of information tools and the overlapping of work with other professions with one's own professional area did not reduce the organizational capacity of the team and promoted positive changes in professional relationships.
Keywords: team medicine, ethnography, information tools
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