Kirsten J Broadfoot*, Sterena.com, Fort Collins, United States Carey Candrian*, Sterena.com, Boulder, United States Track: Practice Presentation Topic: Web 2.0 approaches for clinical practice, clinical research, quality monitoring Presentation Type: Oral presentation Submission Type: Single Presentation Building: MaRS Centre, 101 College Street, Toronto, Canada Room: Auditorium Date: 2009-09-18 11:00 AM – 12:30 PM Last modified: 2009-08-13

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Good relationships between physicians and those they care for is the “cornerstone to the medical system”. It is essential to the provision of high quality health care. However, an increasing number of patients report that they do not trust their doctors. Medical students tell stories of their rotations and observations of practicing physicians wistfully commenting on the ‘old school medicine’ they see performed with some and the harsh realities of the ‘new test based medicine’ they see in others. At the same time, web 2.0 tools facilitate patient and physician centric social networks of healing practice, surgery updates via Twitter, support groups for chronic conditions on Facebook and mobile healthcare over IM and VOIP. Old, new and now digital forms of clinical and communicative practice collide to shed light on our taken for granted assumptions and culturally constructed expectations of medicine and care. As we move from doctor to patient to relationship centered care, how might the participatory web with its commitments to participation, community, empowerment and engagement reconstruct the professional culture and communicative practice of medicine? What might be the consequences of such a transformation for all healthcare participants?

Drawing on ethnographic studies in ER, intensive care, palliative care, cancer and pediatric genetics, and inspired by a dialogic approach to organizing and communicative practice, this presentation proposes that web 2.0 technologies have the potential to reconcile visions of old and new school medicine to create a “space in between”. These "spaces in-between" are places for translation and negotiation, and the disruption and displacement of the dominant structures and practices of clinical life. In such spaces, participants blur boundaries and question established ideas of culture and identity to enable a "spatial politics of inclusion rather than exclusion that initiate new signs of identity and innovative sites of collaboration and contestation". Such hybrid spaces “begin their presencing” at the boundaries of institutions, disciplines and philosophies of care to enable the (re)negotiation of intersubjective and collective experiences of health. They also create a complex architecture of reconfigured organizations in which all participants can connect, re-connect, and create partnerships and associations with others.

Within this new architecture of health, many of the current struggles experienced in healthcare delivery such as the emergence of EMRs, recurring readmissions and conflicting professional roles are not erased, but instead engaged ecologically, as circles of care are expanded technologically to provide support for those who suffer. What emerges in this vision of web assisted relationship centered form of care is health from the ground and around, nothing short of a Reformation of medicine.