importance of technology in medical field essay

The Information Technology in Medicine Essay

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Modern healthcare, being primarily focused on providing quality patient care, cannot exist apart from information technology. For this reason, medical employees are now obliged to learn how to beneficially use technology as well as practice proper communication with patients on the subject of its use in the process of treatment. The discipline, which will be analyzed in the course of the paper, is aimed at defining major tools necessary for providing quality healthcare to the community. Thus, the most significant insight acquired during the course is the high necessity of learning how to convey the importance of information technology to the patients in the simplest way possible.

To begin with, it is necessary to dwell upon the notions that should be processed by the students throughout the course. The subject’s primary goal was to introduce the most common technologies now used in healthcare and their significance to the sphere. Another part of the course was dedicated to the nuance of proper communication with patients using both technology and interpersonal communication.

Before the course enrollment, I considered information technology to be more of an arbitrary helping tool rather than part and parcel of medical practice. However, by the end of the course, I have discovered that the proper use of technology tools can potentially help save hundreds of human lives. Researchers claim that such tools as the Clinical Decision Support System (CDSS) prevent doctors from making false diagnoses due to cognitive overload (Ancker et al., 2017). Besides helping medicals focus more on the treatment process, it is also a key tool for the precise statistical data, crucial for the further development of healthcare across the state.

Another crucial aspect obtained during the course is the ability to assess personal strengths and weaknesses when it comes to cooperation with information systems. As a result, I have discovered that my major strength is the ability to adapt to technology use quite quickly. This benefit also concerns almost all young specialists who are used to information technology from an early age. Such knowledge puts more adolescent specialists at a serious advantage in terms of healthcare system development. However, the skills of fast learning do not concern some patients who are to be educated on the use of technology tools during their treatment process.

According to the researchers, effective patient education is the key to successful treatment due to the patient’s willingness to collaborate (Jimenez & Lewis, 2018). Hence, I believe my major weakness to be the ability to communicate with patients in a way beneficial for their desire to be educated. Despite various already existing methods on patient education, there is still a strong need to develop further research on the topic in order to make it more productive.

In my opinion, the development of healthcare informatics is now rapidly moving towards its zenith due to the beneficial environment. The strategies of further researches are now being planned for the next decades. However, automatized systems of clinical history have introduced the issue of privacy for both patients and medical employees (Iyengar et al., 2018). For this reason, I believe sustaining privacy while maintaining technological advancements in the medical sphere to be one of the most significant topics for further investigation. Moreover, the field of healthcare informatics develops too fast for educators to adapt to the process.

As a result, many specialized educational establishments fail to provide proper students’ preparation on the subject (Ashrafi et al., 2019). Hence, another subject of further investigation should be the methods in which students could be informed of the information technologies used in the field.

Speaking of my personal evaluation of the competencies aligned to the course, the progress is definitely visible by the end of the course, but there are still a lot of details requiring reconsideration. My understanding of the outlines introduced in the course syllabus, including the ability to analyze major programs and methods of computer-human interaction critically is clear and exhaustive. However, in order to maintain the obtained knowledge and skills, there should be more practical tasks, which may help build on the progress. The most valuable output I realized throughout the course is the fact that subjects concerning medicine and technology require constant and comprehensive learning in order to remain relevant in the field.

Taking everything into consideration, it may be concluded that the course of healthcare informatics is an integral part of medical education in the context of the 21st century. In the following reflection of the course, some of its major constituents and outputs were introduced and analyzed. When it comes to personal knowledge and skills gained, the most significant discoveries are the necessity to continually improve on the subject in order to realize how to convey the information to the patients. Even the most advanced technology may be of no help if the patients are not willing to collaborate. Further research on the subject includes more methods for patient education and examination of privacy maintenance.

Ancker, J. S., Edwards, A., Nosal, S., Hauser, D., Mauer, E., & Kaushal, R. (2017). Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system. BMC medical informatics and decision making , 17 (1), 36.

Ashrafi, N., Kuilboer, J. P., Joshi, C., Ran, I., & Pande, P. (2019). Health informatics in the classroom: An empirical study to investigate higher education’s response to healthcare transformation. Journal of Information Systems Education , 25 (4), 5.

Iyengar, A., Kundu, A., & Pallis, G. (2018). Healthcare informatics and privacy. IEEE Internet Computing , 22 (2), 29-31.

Jimenez, Y. A., & Lewis, S. J. (2018). Radiation therapy patient education using VERT: a combination of technology with human care. Journal of medical radiation sciences , 65 (2), 158-162.

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Medical Technologies Past and Present: How History Helps to Understand the Digital Era

• Published: 07 July 2021
• Volume 43 , pages 343–364, ( 2022 )

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• Vanessa Rampton   ORCID: orcid.org/0000-0003-4445-8024 1 ,
• Maria Böhmer 2 &
• Anita Winkler 2  

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This article explores the relationship between medicine’s history and its digital present through the lens of the physician-patient relationship. Today the rhetoric surrounding the introduction of new technologies into medicine tends to emphasize that technologies are disturbing relationships, and that the doctor-patient bond reflects a more ‘human’ era of medicine that should be preserved. Using historical studies of pre-modern and modern Western European medicine, this article shows that patient-physician relationships have always been shaped by material cultures. We discuss three activities – recording, examining, and treating – in the light of their historical antecedents, and suggest that the notion of ‘human medicine’ is ever-changing: it consists of social attributions of skills to physicians that played out very differently over the course of history.

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Human beings have their own goals and intentions, and products should help them to realize them in an optimal way. In many cases, though, these goals and intentions do not exist independently from the technologies that are used. [Technologies] do much more than merely function – they help to shape human existence. Peter-Paul Verbeek (2015, 28)

Introduction

A wide range of novel digital technologies related to medicine and health seem poised to change medical practice and to challenge traditional notions of the patient-physician relationship (Boeldt et al. 2015; Loder 2017; Fagherazzi 2020). A number of recent pieces have explored the ethical implications of this, asking, for example, whether new means of delivering ‘greater efficiency, consistency and reliability might do so at the expense of meaningful human interaction in the care context’ (Topol Review 2019, 22). Various contributions from patients, physicians, bioethicists, and social scientists have warned that computer technologies somehow stand between the physician and the patient and that there is a fundamentally human aspect of medicine that coexists uneasily with machines (e.g. Gawande 2018; Verghese 2017). As a remedy, recent contributions call for ‘clinical empathy’ not only as a desirable characteristic trait of future physicians, but even as a selection criterion for medical students (Bartens 2019). The role history plays in these discussions is striking. Commentators often assume that current concerns about how technologies may lead to the ‘de-humanisation of care’ (Topol Review 2019, 22) are the unprecedented products of technological, social, and cultural transformations in the late twentieth-/early twenty-first centuries. When the history of medicine is referenced, it is largely in one of the following ways: first, to emphasize that today ‘[w]e are at a unique juncture […] with the convergence of genomics, biosensors, the electronic patient record[,] smartphone apps, [and AI]’ (Ibid., 6), whereby the singularity of the digital era makes historical comparisons with antique predecessors seemingly irrelevant. Second, the history of medicine is used in a nostalgic manner to refer to past medical practices, seemingly grounded in the ability of a doctor to ‘liste[n] well and sho[w] empathy,’ as having a fundamentally human element that is threatened by the digital era (Liu, Keane and Denniston 2018, 113; see also Johnston 2018). With some notable exceptions (e.g. Greene 2016, Kassell 2016, Timmermann and Anderson 2006), historians of medicine have largely refrained from attempting to interpret recent digital developments within their broader historical contexts. The historicity of digital medicine in its various forms and the insights of the history of medicine for contextualising the patient-physician relationship in the digital era have yet to be fully fleshed out.

In this contribution, we draw on historical examples and the work of historians of medicine to highlight how all technological devices are ‘expressions of medical change’ (Timmermann and Anderson 2006, 1), and to show how past analogue objects shaped physician-patient relationships in ways that remain relevant today. Our focus is on Western European medicine since the early modern period. While acknowledging the profound differences between medicines in particular historical times and places, we argue, first, that patients and doctors have always interacted in complex relationships mediated by objects. Medical objects and technologies are not only aids for performing certain human tasks, but themselves have a mediating function and impact how physicians and patients alike perceive illness and treatment. We then contend, second, that history helps inform current discussions because it highlights the plurality of ways in which the physician-patient relationship has been conceived in different eras. In particular, the ability of the physician to listen well and show empathy seems to be not so much a historical constant but rather a social attribution of certain skills to physicians that played out very differently over the course of history. Both points help us to show that some of the hopes and fears related to digital technologies are not so entirely new after all.

We work through these hypotheses in relation to three activities in the clinical encounter that have been significantly affected by digital medical technologies, namely i) recording (Electronic Health Records), ii) examining (Telemedicine), and iii) treating (Do-It-Yourself medical devices). In each case, we begin with a specific contemporary technology and the debates around it before showing how a historical perspective can contribute to our understanding of them. First, we discuss electronic health records in the light of current criticisms which maintain that this technology cuts valuable time the doctor should be spending with the patient, thereby threatening an assumed core responsibility of the physician, namely listening empathetically to the patient. History shows that physicians have not always seen administrative record-keeping as foreign to their main work with patients; rather, it has been a formative part of their professional identity at different times. Moreover, the value that both physicians and patients ascribed to empathic listening has varied substantially over time. Second, in the case of examining, we start from the observation that current debates about telemedicine focus on the greater distance between patients and physicians this technology brings about. The historical perspective demonstrates that these debates are but one example of how changing examination technologies affect both physical distance and reciprocal understanding in the patient-physician relationship. Our examples illuminate that physical proximity in the medical encounter is a modern phenomenon, and that it did not always imply a meeting of the minds between physician and patient and vice versa. Finally, our third section on self-treatment demonstrates that Do-It-Yourself devices have the potential to challenge medical authority and, by giving patients more power, alter those power balances between physician and patient that are constitutive of an idealised view of the patient-physician relationship. Yet here too there are significant historical precedents for thinking of doctors and patients as but two players within complex networks of people and technologies, in which patients ascribe value to a multiplicity of relationships.

Record-keeping: computers and the administered patient

Electronic health records (EHRs), that is computer-based patient records, have transformed the way contemporary medicine is practiced (see, for example, Topol, Steinhubl and Torkamani 2015, 353). While the electronic recording of patient files by individual health care providers has become common practice since the 1990s, a central virtual collection and storage of all health data relating to an individual patient is a rather new development which is currently being debated and technically introduced in various states. This virtual patient file is of secondary order because it is fed with original electronic files derived from various primary recording systems (GP, clinic etc.), and it follows a population health surveillance logic rather than the logic of the treatment of individual cases. The main idea is that both patients and health care providers have access to a corpus of health documents, which is as complete as possible, to make diagnosis and treatment more efficient, more precise and safer for patients, and less costly for the health system. While patients may make use of this possibility on a voluntary basis and are asked to distribute access rights to providers, healthcare providers are obliged to cooperate and feed the system with relevant data (for a local example see current implementation efforts in Switzerland and its pitfalls as described in Wüstholz and Stolle 2020). One of the main premises of supporters is that EHRs will facilitate not only networking and interprofessional cooperation but also enhance communication between doctors and patients: they ‘provide health care teams with a more complete picture of their patients’ health [and] improve communication among members of the care team, as well as between them and their patients’ (Canada Health Infoway; see also Porsdam, Savulescu and Sahakian 2016).

Yet critical discussions surrounding the introduction of EHRs doubt exactly that. They suggest that the increasing documentation, virtual storage and sharing of sensitive patient data threatens an assumed historical core value of the doctor-patient relationship, namely the possibility of physicians establishing an intimate and ‘deeper connection’ with their patients (Ratanawongsa et al. 2016, 127). From the perspective of healthcare providers, professionals criticise the time-consuming nature of EHRs, arguing that this technology supplants the time the doctor has for direct communication and time spent ‘in meaningful interactions with patients’ (Sinsky et al. 2016, 753). That screens are coming ‘in between doctors and patients’ is a widespread notion (Gawande 2018). In addition, medicine’s increasing dependence on screens is perceived as undermining important social rituals, such as exchanges between physicians and other healthcare colleagues who used to discuss their cases in more informal ways (Verghese 2017). Last but not least, EHRs are seen as a major factor contributing to declining physician health and professional satisfaction because of their time-consuming data entry that reduces face-to-face patient care (Friedberg et al. 2013). This last point seems to be crucial as the digital interfaces of EHRs indeed require a maximum of standardisation, homogenisation and formalisation of recording styles that necessarily conflicts with more informal, individual recording techniques. On the one hand, doctors are forced to fill in fields and checkboxes that do not correspond to their own knowledge priorities, that is the things they would want to highlight in a certain case from the perspective of their specialty. On the other hand, they have difficulties in identifying relevant information when too much data on an individual patient has been entered by too many people. The desired interprofessional collaboration thus runs the risk of complicating instead of facilitating the making of a diagnosis. Surgeon Atul Gawande maintains that in the past, analogue documentation forced physicians to bring essential points into focus: ‘[d]octors’ handwritten notes were brief and to the point. With computers, however, the shortcut is to paste in whole blocks of information […] rather than selecting the relevant details. The next doctor must hunt through several pages to find what really matters’ (2018). Together, these points of critique suggest not only a certain fear that the increasing digitisation of patient records might disturb relationships that in the pre-digital era were based on professional intuition and meaningful, trust-building face-to-face communication. The critique also suggests that what is threatened is the meaning and satisfaction a physician takes from his/her recording work.

From the perspective of patients, other concerns related to EHRs are more relevant, among them the safety of personal health data. But while notions of privacy – who has control over the data, who owns the patient history – are important for patients, a number of studies also show that patients perceive the careful digital documentation of their case as something positive (Assis-Hassid et al. 2015; Sobral, Rosenbaum and Figueiredo-Braga 2015). ‘Forced to choose between having the right technical answer and a more human interaction, [patients] picked having the right technical answer,’ reports Gawande (2018; see also Hammack-Aviran et al., 2020). It thus seems that as long as patients think EHRs are providing them with a higher quality of care, they readily accept EHRs and their doctors’ dependence on screens – hence adapting their expectations to technological change.

In order to scrutinize these purported threats and attitudes towards EHRs, the rich history of patient records provides a relevant historical backdrop. In studying patient records, historians have addressed exactly these issues: they have examined how the patient-physician relationship has changed over time and have used medical records to gain insights into how past physicians documented medical knowledge, how this influenced their perceptions of their professional identity, and their obligations vis-à-vis patients (Risse and Warner 1992). As a first step, it is important to see that even though EHRs pose new challenges because of their digital form, recording individual patients’ histories as part of medical practice and ‘thinking in cases’ as a form of epistemic reasoning are a historical continuum (Forrester 1996; Hess and Mendelsohn 2010). The patient history dates to ancient Hippocratic medicine when detailed medical records were written on clay tablets and handed down for centuries to preserve the esteemed knowledge of antiquity (Pomata 2010). Yet the content and form of medical records, as well as the practices producing them have changed remarkably over time (Behrens, Bischoff, and Zelle 2012). In Western Europe, physicians in sixteenth-century Italy re-appropriated the ancient practice and typically recorded their cases in paper notebooks, as part of a larger trend to systematize and record information (Kassell 2016; see also Pomata 2010). As Lauren Kassell notes, the records of early modern practitioners ‘took the form of diaries, registers or testimonials, often they were later ordered, through indexing or commonplacing, by patient, disease or cure, providing the basis for medical observations, sometimes printed as a testimony to a doctor’s expertise as well as his contribution to the advancement of science’ (2016, 122). The historical perspective reveals that the rationale for a particular type of medical record-keeping always developed in tandem with the technical capabilities for its enactment, changing ideas of how diseases should be recorded, as well as with the preferences of individual physicians (ibid. 120). Crucially, as the organization of these collections of patient histories changed, so too did medical knowing and normative ideas about the physician-patient relationship (Hess and Mendelsohn 2010; Dinges et al. 2016).

As shown above, current critical discussions about EHRs tend to evoke a medical past in which patients were given time to talk about their illness, doctors listened and engaged in meaningful interactions, and record-keeping did not interfere with these processes. Allegedly, there were few concerns over misuse of data as there was less data produced and fewer players in the game. How does this popular nostalgic view correspond to research findings in the history of medicine? To some extent, the context of ‘bedside medicine’ comes close to these ideas. This model of care remained dominant in Western Europe until the nineteenth-century. One of the main ways in which physicians generated medical knowledge at the bedside of patients was to conduct ‘verbal analysis of subjectively defined sensations and feelings’ by patients (Jewson 1976, 229-230), and these patient testimonials provided the details recounted in physicians’ notes (Fissell 1991, 92). This is partly because the early modern doctor-patient relationship was based on a ‘horizontal’ model of healing (Pomata 1998, 126-27, 135) and a legally binding ‘agreement for a cure’ (ibid., 25 passim), which gave considerable power to patients, placing them on ‘near-equal hermeneutic footing’ with doctors (Fissell 1991, 92). Physician and patron (patient) made a contract in which the mostly upper class-patient would only pay fees after ‘successful’ treatment; vice versa, doctors were not obliged to treat a patient but would rather take on patients whose potential cure, and ability to pay fees, could be foreseen. Patients’ verbal satisfaction and willingness to conduct word-of-mouth publicity for a practicing physician were key to his reputation at that time and influenced physicians’ relationships with their clients.

However, it is problematic to project today’s vision of a desirable empathic relation between doctors and patients back into the past. Although upper-class patients clearly had some power in their relationship with physicians, the dominance of patients’ speech in medical records as such should not be interpreted as proof that doctors cared about their patients in the modern sense of showing understanding. With respect to nineteenth-century bourgeois medicine, Roy Porter noted that flattery and attention in the medical encounter were calculated practices of physicians concerned to secure clients and that ‘solemn bedside palaver[,] a grave demeanour, an air of benign and unflappable authority’ were all part of the prized ‘art of never leaving without a favourable prognosis’ (1999, 672). In a similar vein, Iris Ritzmann has emphasized that eighteenth-century doctors were eager to adhere to a certain ‘savoir faire,’ that is rules of conduct that would allow them to obscure the fact that in many cases, their abilities to heal were very limited (1999). And in Paul Weindling’s assessment of German medical routines, physicians’ desires to satisfy the patient subjectively were even purely instrumental: ‘[s]ympathy with the feelings of the sick was an economic necessity owing to the competition between practitioners’ (1987, 409). In all these cases, the value ascribed to direct physician-patient dialogue was very different from today’s ideas about an empathic encounter between physicians and patients; an engaged bedside manner often had more to do with calculated support for an upper class and sometimes hypochondriac clientele.

Similarly, as concerns the careful documentation of a patient’s medical condition and history, historical evidence shows that doctors did not do it primarily for their patients’ needs but for purposes of professional standing. This was important at a time when physicians’ scientific authority still needed to be established. The fact that in many cases there were several physicians involved in the treatment of the same case made documentation and communication between physicians (and sometimes for the public) especially relevant – and especially conflictual. Eighteenth-century case histories reflecting the context of bedside medicine indeed suggest that doctors were sometimes eager to publish case histories of patients that would bespeak their ability to heal by highlighting the misfortune of their competitors in order to enhance their own reputation. This shows how misleading the popular nostalgic view of a past intimate and unbroken bond between physicians and patients is, and that analogue paper technology did not necessarily strengthen this bond but could also be used in ways that were not beneficial for patients. Unlike today, this was an era in which practices of record-keeping mirror multiple, local and highly individual ways of documentation; the formalisation and standardisation of patient files which 19 th -century hospital medicine would trigger was yet to come.

As hospitals and laboratories became important institutions for medicine in the century roughly between 1770 and 1870, they also changed the practices of record-keeping, as the customary interrogation of patients’ accounts of the course of their disease did not coincide with changing understandings of disease, scientific interests and cultural expectations (see Granshaw 1992). For instance, French anatomist and pathologist Xavier Bichat (1771-1802) dismissed note-keeping based on patients’ narratives as an obsolete method for knowledge-making. He observed in his Anatomie générale (1801), ‘you will have taken notes for twenty years from morning to night at the bedside of the sick [and] it will all seem to you but confusion stemming from symptoms that fail to coalesce, and therefore provide a sequence of incoherent phenomena’ (1801, xcix, our translation). The kind of medicine favoured by Bichat and like-minded physicians focused on gaining anatomical and physiological insights directly from the body, using both physical examination and remote techniques in the laboratory. One way in which record-keeping changed to accommodate these interests was in the use of a more technical language to describe the experiences and expressions of patients. Mary Fissell argues that with the rise of hospital medicine, ‘doctors begin to sound like doctors, and patients’ voices disappear’ because doctors interpret patients’ words and replace them with medical equivalents (1991, 99). More generally, historians have shown that during the nineteenth century, medical culture changed in a way that gradually diminished the importance of patient narratives in medical writing (Nolte 2009).

How did these changes in recording practices play out for patients in the medical encounter ? From the historical perspective, the fact that physicians adopted a more technical language in their interactions and records should not be taken as evidence for a loss of human interaction or as something that patients necessarily disliked. On the contrary, the more systematised and formalised type of record-keeping was considered state of the art and was in accordance with a rapidly growing belief in the natural sciences among both patients and the general public (Huerkamp 1989, 64). This is related to the emergence of a specific concept of scientific reasoning that, in turn, fostered a sense of ‘scientific objectivity’ that called for dispassionate observation and accurate recording (Daston and Gallison 2010; Kennedy 2017). By the end of the nineteenth century, academic physicians had managed to create such professional authority that the ‘horizontal model of healing,’ in which the physician courted his upper-class clients, was replaced by a vertical model, in which the patient subjected himself to the authority of the physician. A Berlin doctor advised his fellow colleagues in 1896 that they should communicate their medical prescriptions to patients in a way that ‘prevents any misunderstandings and so that no further question can be addressed to him’ (cited in Huerkamp 1989, 66, our translation). For patients, this growing scientific authority and paternalism meant very different things, depending on class and social status. While medical services became accessible to more people, in particular thanks to the introduction of obligatory health insurance for workers, lower classes often experienced medicine as an instrument of power rather than benevolence (Huerkamp 1989). But even for the well-to-do, who undoubtedly benefitted from newly developed medical techniques, in particular in the realm of surgery, the acceptance of medical paternalism, male rhetoric and heroic cures came with high costs. This is suggested, for instance, in a famous letter by the court lady and writer Frances (Fanny) Burney who underwent a mastectomy in 1811, a rare document offering a patient’s perspective on these matters (Epstein, 1986).

From the perspective of doctors at the turn of the nineteenth century, record-keeping was associated not only with professional obligations but also with personal fulfilment. In many European countries, physicians were asked to provide expert opinion for juridical and administrative regulations as the state was increasingly interested in tracking its population’s health (Ruckstuhl and Ryter 2017; Schmiedebach 2018). In her study of Swiss physician Caesar Adolf Bloesch’s private practice (1804-1863), Lina Gafner shows the extent to which he perceived medical practice documentation as constitutive of his professional role and self-understanding as a medical expert. Bloesch’s patient journal ‘constitutes one single gigantic research report’ (2016, 265) because it was key for allowing him to generalize from the experiences gained in his practice in order to produce knowledge to contribute to contemporary scientific discussions. Gafner notes that the ‘format he gave his journals [leads] us to assume that scientific or public health-related ambitions were part of Bloesch’s professional self-image’ (263). In contrast to this historical example, where patient care and journal keeping were combined in the light of professional ambition, it stands out that healthcare providers of today tend to see their administrative work as opposed to patient care, even as separate and conflicting tasks; it is assumed that for physicians ‘seeing patients doesn't feel like work in the way that data entry feels like work’ (Amenta 2017). This is probably related to the fact that many physicians experience the requirement of working with a given software as a limiting restraint, which they are not really able to control, while they experience working with patients as something they have learned to master. As Gawande admits: ‘a system that promised to increase my mastery over my work has, instead, increased my work’s mastery over me’ (2018). It thus seems that it is primarily the question of ownership that distinguishes past recording styles from today’s recording systems: it is difficult to individually appropriate something which is designed to harmonize if not eliminate individual recording styles.

Yet even as Bloesch and contemporaries embraced the administrative tasks associated with medical note-taking as an opportunity to become a medical expert, other nineteenth-century physicians had different views of its value. But their criticisms of record-keeping were not motivated by the inherent value they saw in interactions with patients. Rather, their critiques were linked to a notable shift during the nineteenth century as scientific interest, triggered by administrative requirements as well as different disease conceptions and methods (e.g. in epidemiology research), changed its focus from the individual case study to population studies (see Hess and Mendelsohn 2010). In Nikolas Rose’s words, ‘the regularity and predictability of illness, accidents and other misfortunes within a population’ became ‘central vectors in the administration of the biopolitical agendas of the emerging nation states’ (2001, 7). Bound up with a new emphasis on tabulation, as well as ‘precision and reliability,’ various German-speaking hospitals instigated a new tabular format designed to enable physicians to compile their observations of patients into ward journals organized into columns and, eventually, generate an annual account of the course of disease (Hess and Mendelsohn 2010, 294). Yet in response some physicians rejected what they saw as excessively confining recording requirements. Volker Hess and J. Andrew Mendelsohn describe how the chief physician at a Berlin clinic ranted about the ‘inadequacy of our [tabular] journals’ and their inability to produce medical knowledge (295). While Mendelsohn and Hess themselves remark that such tabular ward journals were very ‘far from the patient history as observation, as prose narrative’ (293), the physicians’ rejection of the use of columns to record cases was not motivated by a concern to recover patients’ own narrations of their ailments or the feeling that record-keeping prevented them from properly attending to their patients’ needs. On the contrary, these physicians were concerned with producing an annual disease history and were frustrated that ‘the ultimately administrative format’s own rigid divisions blocked the writing of a synoptic history’ (296). Rather than recovering a face-to-face encounter with patients, they were interested in finding a recording format that would allow them to present a more compelling and sophisticated general description of disease, relying on mass information.

The current consensus among historians of medicine is that we should neither conceive medical records as ‘unmediated records of experiences of illness and healing’ (Kassell 2016, 126) nor as disentangled from the medical encounter itself. Rather, ‘processes of record-keeping were integral to medical consultations’ because ‘as ritualised displays and embodied knowledge, case books shaped the medical encounters that they recorded’ (122; see also Warner 1999). In relation to how ‘computerization’ is shaping contemporary medical encounters, three main points are of note. First, physicians have not always seen time spent writing and recording patient histories as in competition with interacting with patients themselves. At various times in history, the careful documentation of individual cases was perceived as a fundamental resource for generating medical knowledge and time spent doing so as part of the self-identity of physicians. Against the repudiation of digital record-keeping by today’s physicians, historical evidence shows that to the extent that physicians saw record-keeping as coinciding with their overall knowledge objectives, they accepted and even embraced it. This is linked to a second point, namely that prolonged time spent listening to the patient talk was not historically seen as evidence of good medical practice. For example, in an era when listening at length to patients was associated with the obsequious physician catering to the ego of the upper-class patient, the sober inscription in a nineteenth-century casebook noted that ‘too much talking showed that little was wrong’ with the patient (Weindling 1987, 395). Finally, patients too accepted administrative work by doctors as a sign of expertise and not necessarily as something that reduced the doctor’s attention to them. While the power balance changed in favour of doctors and ascribed less epistemic value to patients’ words, this was not necessarily negatively received by patients. History therefore shows that we should not view technological changes as isolated from the broader medical culture surrounding them but rather as shaping and co-constructing this culture. Today’s fear that the introduction of EHRs might change the communication and relation between physicians and patients for the worse tends to blame technology for a broader cultural and medical change of which it is just one tiny aspect, that is the growing belief in data and the logic of gaining stratified knowledge to provide relevant information about any one patients’ condition. Given that patients’ expectations exist in a dynamic relationship with how physicians learn, make decisions and interact with them, EHRs are themselves bound up with creating new conditions for the physician-patient relationship.

Examining: telemedicine and the distant patient

A further way in which digitalization has influenced the medical encounter is that it has emerged as the new virtual consulting room, thereby radically transforming the settings and procedures of physical examination. Although most people still go to ‘see the doctor,’ medical encounters today no longer have to take place in physical spaces but can occur via telephone or internet – what is broadly referred to as telemedicine, literally healing at a distance (from the Greek ‘tele’ and Latin ‘medicus’) (Strehle and Shabde 2006, 956). According to the World Health Organization, as a global phenomenon, telemedicine is more widespread than EHRs with more than half of responding member states having a telehealth component in their national health policy (WHO 2016). In the context of the COVID-19 pandemic, telemedicine has been overwhelmingly seen as ‘[a]n opportunity in a crisis’ and has further gained in popularity (Greenhalgh et al., 2020; see also Chauhan et al., 2020). A senior NHS official cited by The Economist called the widespread adoption of remote care (viz. telemedicine) a ‘move away from the dominant mode of medicine for the last 5,000 years’ (2020, 55). In the virtual examination room, patients can ask a physician for a diagnosis, a prescription and a treatment plan and send information about diseased body parts via digital media. When inquiring about the health conditions of their patients from a virtual consultation room, physicians sometimes need to ask their patients for certain practices of self-examination and self-treatment (Mathar 2010, section III). Advocates of telemedicine emphasize that there is no risk of mutual infection, advantages of cost savings, convenience, and better accessibility to medical care generally and for people living in rural and remote areas in particular. In Switzerland, for instance, the Medgate Tele Clinic promises to ‘bring the doctor to you, wherever needed’ (2019) while the U.S. Doctor on Demand characterizes itself as ‘[a] doctor who is always with you’ (2019). Patients, meanwhile, appreciate the greater availability of physicians, less travel time and better overall experience (Abrams and Korba 2018). However, telemedicine also raises various critical questions about the effects of physical distance on the physician-patient relationship. In particular, can the quality of the examination and diagnosis be high enough if a physician only sees his/her patient via screen but cannot smell, palpate and auscultate him/her? Furthermore, how can a trusting doctor-patient relationship be established virtually and at a distance? (see Mathar 2010, 13). While some of these critiques are based on the assumption that a fitting medical encounter between physician and patient should be a ‘good, old-fashioned, technology-free, dialogue between physician and patient’ (Sanders 2003, 2), we show below that all encounters inevitably ‘pass through a cultural sieve’ (Mitchell and Georges 2000, 387). Not only has the perceived need for the physical proximity of physician and patient varied substantially over history, but historical physicians and patients have not seen physical distance as preventing them from achieving emotional understanding. Whether physical examinations took place in-person or remotely, at each point in history doctors relied on their knowledge and its applications, that is a cultural lens through which s/he gazes on, over or into the human body. Regardless if examined remotely or closely, changes in examination procedures always challenge the established sense of the emotional bond between patient and physician, which therefore needs to be defined anew.

The standard physical examination as we know it today was considered less important in Europe up to roughly 1800 because of the conventions governing the relationship between physician and patient/patron, and also because of the conventions governing the relationship between male doctor and female patients. Many physicians considered physical examination morally inappropriate and saw it as dispensable for making a diagnosis. Physicians of upper-class patients generally considered their task more to advise than to examine and treat (Ritzmann 1999, 203). From his close analysis of a casebook by a seventeenth-century English physician, Stanley Joel Reiser concludes that the ‘maintenance of human dignity and physical privacy placed limits on human interaction through touch’ (1978, 4). Given the desirability of maintaining physical distance, physicians relied on and developed other sources of knowledge than their own sense of touch. The physical examination was ‘the method least used’ by the seventeenth-century physician who rather favoured ‘the patient’s narrative and [his] own visual [outward] observations’ of the patient’s body. In her study of a manuscript authored by a surgeon-apothecary of the same historical period, Fissell singles out blood-letting as one ‘of the few occasions on which a professional […] might routinely touch a patient’ and notes that it was necessarily ‘transformed into a careful ritual, one which attempted to compensate for the transgressive nature of the encounter. The blood-letter's courteous attention to returning the patient to his or her un-touched status underlines the mixture of courtesy and technique which made good medical practice’ (1993, 23). In ways now unfamiliar to us, manners and morals interacted to make physical examination and touching patients an ancillary part of the desirable patient-doctor encounter at that time.

Regular in-person physical examination as a routine practice and diagnostic technology is a rather recent development that came along with a new anatomical understanding of disease during the course of the nineteenth century, namely that diseases can be traced to individual body parts such as organs, tissues and cells, rather than unbalanced bodily humours (Reiser 1978, 29). It was at this time that the doctor’s examination skills no longer depended on the patient’s word and the surface of the (possibly distant) body, but started relying on what the doctor could glean from the patient’s organic interior (Kennedy 2017). In order to ‘get’ to the physical conditions of the body’s interior, a number of instruments were developed to facilitate the new credo of examination. The most famous example of such a nineteenth-century examination technology is the stethoscope, invented by French physician René Laennec (1781-1826). ‘By giving access to body noises – the sounds of breathing, the blood gurgling around the heart – the stethoscope changed approaches to internal disease,’ wrote Roy Porter, ‘the living body was no longer a closed book: pathology could now be done on the living’ (1999, 208). Crucially, technologies like the stethoscope brought the physician and patient into the examination room together but by providing physicians with privileged access to the seat of disease did not necessarily bring them closer in terms of understanding. Doctors now heard things that remained unheard to the patient, and this provoked a distancing in terms of illness perceptions. In Reiser’s account, the stethoscope ‘liberated doctors from patients and, by doing so, paradoxically enabled doctors to think they helped them better. […] Listening to the body seemed to get one further diagnostically than did listening to the patient’ (2009, 26).

The result is visible in the resistance surrounding some examination technologies that allowed physicians to delve into the body’s interior in order to gain new anatomical and pathological insights but that proved too transgressive for some existing physician-patient contacts. The vaginal speculum, introduced into examination procedures in Paris in the early-nineteenth century, may have fitted well with physicians’ new commitments to empiricism and observation. But at the time of the speculum’s introduction, female genital organs, in contrast to other organs, were regarded ‘as so mysterious and so sacred that no matter how serious the disease that afflicted them might be, it was no justification for an examination either by sight or touch’ (Murphy 1891, cited in Moscucci 1990, 110). Although the speculum was in line with pathological disease concepts and close, interior observation, moral considerations continued to undermine its suitability in the clinical context. At a meeting of the Royal Medical and Chirurgical Society, chronicled in the Lancet , commentators associated the speculum with both female and physician corruption, and the loss of moral virginity and innocence caused by its insertion into the body (Anon. 1850). In Margarete Sandelowski’s estimation, the vaginal speculum ‘required physicians not only to touch women’s genitals, but also to look at them, and thus imperiled the relationship male physicians wanted to establish with female patients’ (2000, 75). Here was a case in which technology challenged the socially accepted relationship between (male) physicians and (female) patients of a particular class because its application demanded increased physical closeness, and therefore was seen as undesirable and transgressive. As Claudia Huerkamp notes, it took a long time to establish a specific ‘medical culture’ in which the physical examination of female parts by a male physician was not perceived as breaking a taboo (1989, 67).

In other instances, the use of the speculum and the unprecedented access it provided to women’s anatomy mirrored existing power structures. The first uses of the speculum were justified in reference to and tested on the most vulnerable members of society. Deirdre Cooper Owens (2017) has demonstrated that in the U.S., racist arguments helped to defend the speculum’s application and experimentation on black, enslaved women as they were deemed to have a particularly ‘robust’ constitution, high tolerance of pain, and so on. Medical men such as James Marion Sims, who by his own account was the inventor of the speculum, combined his privileged access to enslaved women’s bodies with intrusive forms of examination in order to gain new knowledge crucial for the emerging field of gynaecology. This was also true for Irish immigrants in the U.S. (Owens 2017) and in the case of prostitutes in France and Germany, where the speculum was used as an instrument of the medical police (Moscucci 1990, 112). Prostitutes were screened using this new instrumentation as supposed carriers of venereal disease, whereas male clients did not need to undergo any screening. This highlights how intrusion into the body in the name of more accurate examination was frequently bound up with power and control, especially of marginalized groups.

Even as the seat of disease became increasingly associated with specific locations inside the body, this coexisted with the notion that medicine could still be conducted ‘at a distance.’ The example of the telephone demonstrates how tele-instruments worked alongside close examination devices that adhered to the principle of disease as located in particular interior body parts. In fact, the potentiality of the telephone for the medical profession was apparent from its invention in 1876; 4  as Michael Kay notes, the first inter-connected users were doctors, pharmacists, hospitals and infirmaries (2012). Practitioners used the technology, which enabled the clear transmission and reproduction of complex sounds for the first time, to improve existing instruments, or to devise entirely new examination methods. For instance, in November 1879, the Lancet published the case of an American doctor who, when phoned in the middle of the night by a woman anxious about her granddaughter’s cough, asked for the child to be held up to the telephone so that he could hear it (Anon. 1879). A group of physicians predicted in 1880 that home telephones would allow a new specialty of long-distance practitioners to ‘each settle themselves down at the centre of a web of wires and auscult at indefinite distances from the patients,’ potentially replacing the traditional stethoscope (cited in Greene 2016, 306). The telephone was also lauded for its potential to uncover foreign objects lodged in patients’ bodies, for example by acting as a metal detector (see Kay 2012). In line with the belief that a ‘good examination’ required a physician having access to the body’s interior in order to discover the seat of disease according to the localisation principle, the telephone was seen as an extension of the doctor’s ear that could improve examination and diagnosis.

In this context, reactions to the increased physical distance between physician and patient varied. The benefits of using a telephone instead of the more traditional speaking tube, which allowed breath to pass from one speaker to another, when communicating with patients with contagious diseases were recognised very early (Aronson 1977, 73). A testimonial letter, written by the Lady Superintendent at the Manchester Hospital for Sick Children in 1879, stated: ‘[The recently installed telephone] is of the greatest value in connection with the Fever Ward, enabling me to always be in communication without risk of infection’ (cited in Kay 2012). Yet some physicians worried that telephone technology had effectively ‘shrunk’ perceived social distance between them and the working classes, making them liable to be overly contacted by the general public. As one doctor complained in the Lancet in 1883: ‘[a]s if the Telegraph and the Post Office did not sufficiently invade and molest our leisure, it is now proposed to medical men that they should become subscribers to the Telephone Company, and so lay themselves open to communications from all quarters and at all times. […] The only fear we have is that when people can open up a conversation with us for a penny, they will be apt to abuse the privilege […] ’ (cited in Kay 2012) . Not only were doctors concerned about the telephone invading their ‘leisure,’ they worried that they might be overrun by the public, and their medical expertise would be needlessly exploited. Because of the inherent fear of doctors that an excessively frequent use of the telephone could flatten the social order and their standing within society, it is not surprising that the public use of the telephone came under critical medical scrutiny. This is visible in the way that telephones themselves came to be seen as seats of infection. At the end of the nineteenth century when most telephones were for public use (Fischer 1992), the British Medical Journal cautioned there was a need to curtail ‘the promiscuous use of the mouth-pieces of public telephones’ (Anon. 1887, 166). In general, the use of the telephone was informed by insights from bacteriology, which transformed individual disease ‘into a public health event affecting communities and nations’ (Koch 2011, 2), and placed new emphasis on the need to keep potentially infectious bodies as well as social classes at clear distance from one another (see Peckham 2015).

In relation to the pitfalls of today’s telemedicine and the fundamental questions of physical distance and emotional rapprochement in the medical encounter, these historical findings demonstrate that what was perceived as the ‘normal’ setting and procedure of medical examination could change remarkably within a rather short time. Before the nineteenth century, close physical examination generally played a less prominent role while patients’ illness accounts had a greater weight in the medical encounter. Indeed, in some contexts physical distance was seen as the prerogative of good medical practice. Post-1800, by contrast, is characterized by the standardisation of physical close examination, but also by the introduction of new technologies into the patient-physician relationship that themselves challenged socially-accepted degrees of physical closeness. However, this does not necessarily mean that such technologies disturbed a former unbroken bond, rather, various technologies became players in the game and could (or not) be appropriated by patients and doctors alike. Technology did not simply affect the physician-patient relationship, rather, existing societal and moral understandings influenced how technologies came into being and how they were used (Peckham 2015, 153). Our historical examples suggest that rather than seeing telemedicine as something fundamentally new and potentially threatening because it seemingly undermines a personal relationship, it may be more useful to acknowledge that technologies and cultural understandings always govern the degree of physical closeness and distance in medical encounters, and that this has had manifold implications for the emotional doctor-patient bond. The success of telepsychotherapy during the Covid-19 pandemic is perhaps a case in point. Even as it is unique among medical specialities because of the extent to which it considers the human relationship as fundamental for healing, psychotherapy via phone or video link has increased dramatically during the public health crisis, and also had good results (Békés and Aafjes-van Doorn 2020). This points not only to how physician-patient closeness and emotional understanding can exist in times of physical distance, but also to the constantly variable ways in which both the cultural imagination and experience of distance manifest themselves (Kolkenbrock 2020).

Self-treatment: do-it-yourself medical devices and the expert patient

The third field of digital medicine that we would like to put into historical perspective is one of the fastest growing fields of eHealth, namely do-it-yourself (DIY) health technologies. Such technologies broadly refer to the mobile devices that ‘now allow consumers to diagnose and treat their own medical conditions without the presence of a health professional’ (Greene 2016, 306). Silicon Valley firms sell ‘disintermediation,’ that is the possibility of cutting out middlemen – physicians – and allowing consumers to better control their health via their devices (Eysenbach 2007). Significant private investments have been driving these changes which, in the forms of smart devices and wearable technologies, often imply purchasing a product (e.g. a smartphone) and related applications and tools (see Greene 2016; Matshazi 2019). The website Digital Trends 2019 ranking of ‘the 10 best health apps’ range from Fitocracy, a running app that allows you to track your progress and that promises a fitness experience with a ‘robust community of like-minded individuals’, to Carbs that transfers the meals you have eaten into charts of calories, to Fitbit Coach that promises you the experience of having a personal trainer on your smartphone (de Looper 2019). 5 Health systems have bought on and increasingly ask patients to observe and monitor themselves with the help of these technologies, and in some cases, the use of apps to measure blood pressure, pulse and body weight such as Amicomed and Beurer HealthManager are closely connected to the possibilities of sharing one’s data remotely with a physician. In terms of reception, the delegation of tasks to digital devices is associated with patients having new options and new knowledge of their own health. In the estimation of one hospital CEO, this dramatic ‘democratization’ of technology and of knowledge signals ‘a true coming of age of the patient at the centre of the healthcare universe’ (Rosenberg 2019). In the words of chronic patient and patients’ rights advocate Michael Mittleman, while there may be benefits for patients when technologies take over certain tasks that were previously the prerogative of physicians, such technologies nevertheless pose a fundamental challenge to the ‘golden bond’ that previously characterized the patient physician-relationship, for example in the age of the house call (conversation with the author, 2019). It is clear from these statements that DIY devices – because they suggest that the more beneficial relationship is that between the patient/consumer and his/her devices – challenge previous assumptions about the inherent value of the physician-patient relationship as well as the balance of power between those two actors (see Obermeyer and Emmanuel 2016).

Both the notion that patients inherently benefit from circumventing physicians and taking their health into their own hands, as well as the idea of a close, almost familial bond that characterized the physician-patient relationship prior to contemporary DIY practices can be nuanced if we acknowledge that do-it-yourself medical practices have a long and varied history. As Roy Porter has noted, in the eighteenth-century, ‘ordinary people mainly treated themselves, at least in the first instance[,] “medicine without doctors” [was] a necessity for many and a preference for some’ (1999, 281). Only in the nineteenth-century did the medical profession establish a monopoly in health care and have the official power to determine what was ‘health’ and ‘sickness’. In the previous centuries, local and pluralistic ‘medical markets’ embraced far more providers of health services and their varied tools, including barbers, surgeons, quacks and charlatans, so that patients chose among the options that most convinced them or that were affordable to them (Ritzmann 2013, 418). But patients also had the option to help and treat themselves using the means at their disposal – Fissell argues that a person who fell ill in 1500 and still in 1800 almost always first sought medical treatment in a domestic context: ‘[h]e or she relied upon his or her own medical knowledge of healing plants and procedures, consulted manuscript or printed health guides, and asked family, neighbors, and friends for advice’ (2012, 533). As Fissell points out, the enormous diffusion and importance of self-therapy at the time meant that the ‘boundary between patients and practitioners was hard to pin down’ (534). While current depictions of an idealised interaction between physician and patient assume a physician who through his/her knowledge examines, advises and treats the non-knowing patient, history shows that the presumed boundaries between the expert and lay person are far more blurred than is usually assumed.

The presumed novelty of a de-centralised market for DIY devices that potentially threatens the dual relationship between physicians and patients can be put into perspective when considering historical examples. Due to a fairly unregulated medical market in the early modern period, competition was high and the business of medicinal recipes lucrative. In this context, profit-motivated apothecaries benefited from offering new recipes made from exotic products: as of the fifteenth century European pharmacies stocked many wares with medicinal properties – including spices, elements such as sulphur, and plants, for examplemastic and sundew – and these were bought by people who gathered and dealt in medicinal plants (or ‘simples’) and other apothecaries, who made them into medicines. In the wake of the European voyages of discovery, the range of products became ever wider and more expensive, and apothecaries were a very profitable business branch for a long time (Ehrlich 2007, 51-55). King and Weaver have used evidence from remedy books in eighteenth-century England to show how families purchased recipes for remedies, and resold both the recipes and the medicines they brewed to other local people (2000, 195). Until the nineteenth century the medical market flourished and was accessible and lucrative for many participants, while the demand for ‘medical’ services was high, particularly in towns and cities. Access to the technologies of healing – whether domestic medical guides or healing herbs – allowed patients to control their health and treatments according to a wide range of scientific explanations. In contrast to other European countries that meanwhile had developed some restrictions for apothecaries and their suppliers, in Britain the market-place was remarkably varied in the light of the free-market principle caveat emptor (let the buyer beware). ‘In English conditions,’ wrote Porter, ‘irregulars, quacks and nostrum-mongers seized the opportunities a hungry market offered’ (1995, 460). In these conditions of market-oriented healing, both patients and healers alike believed, sometimes fervently, in the effectiveness of the remedies on offer. Moreover, the network of relationships in which such transactions took place was remarkably fluid, with patients using the services of several health professionals in succession or simultaneously.

In the following centuries, medical practice and science would change dramatically due to the rise of academic training as a prerequisite to enter the medical profession, a development seen across Europe, as well as the integration of physicians into national health agendas. A growing belief in science and a paternalistic ideal of the academic physician attributed to him the sole power over medical practice and technologies. It became more difficult for other healers to participate in the health market, and the knowledge of the self-treating patient was diminished as well. As part of the attempt to counteract competition from non-educated or apprenticed healers, in the United Kingdom only registered doctors could hold various public posts, such as public vaccinator, medical officer and the like (Bynum 2006, 214). Yet ‘alternative’ medicine, a term that contained all those healers not licenced and accepted by the respective medical registers, continued to satisfy patients’ needs, although to a lesser extent. In Weindling’s assessment of the prospects of university-educated physicians to attract clients in nineteenth-century Berlin, ‘[f]ierce competition from a range of unorthodox practitioners must be assumed’ (1987, 398). The popularity of hydropathic doctors and water cures, mud-bathing and vegetarianism are but some examples of how alternative medicines co-existed alongside official ones and were increasingly popular treatments even though they did not meet the contemporary academic criteria of standards regarding safety and efficacy (Ko 2016). Thus patients often looked beyond qualified physicians to other practitioners, and their own sensibilities played a considerable role in which relationships they chose to develop.

A look into twentieth-century history shows that DIY practices were integrated into official medicine as well (Timmermann 2010; Falk 2018). The significant rise of chronic diseases and life-long treatment, for instance, required the co-operation of patients in the form of self-tracking and observation of their bodies since it could not be done by medical experts alone. In the first decades of the twentieth century, DIY methods and technologies for measuring blood pressure or sugar became particularly vital, transforming the roles of ‘patient’ and ‘doctor’ and relationship between them. Examining the history of self-measuring blood pressure, Eberhard Wolff notes that patients doing so in the 1930s required both patience and training, and also were pushed into a more active and participatory role during medical treatment: it was not the doctor anymore but the patient who produced and controlled relevant data that were decisive for further medical decisions and treatment (2014, 2018). With the rise of the risk factor model in mid-twentieth century – the identification of factors in patient’s behaviour and habits that were suspected of contributing to the development of a chronic disease – DIY practices grew ever more important and so did its technologies. From this moment, the idea of preventing disease shifted towards individual, possibly damaging behaviours such as smoking and diet that could trigger a number of different diseases. As a consequence, the patient received more responsibility in order to live up to the new credo of maintaining his or her personal health (Lengwiler and Madarász 2010). Optimizing a personal healthy life style hence did not necessarily occur in direct consultation with a doctor but rather in conjunction with health products available on the market. In the words of sociologist Nikolas Rose, in the course of the twentieth century:

[t]he very idea of health was re-figured – the will to health would not merely seek the avoidance of sickness or premature death, but would encode an optimization of one’s corporeality to embrace a kind of overall “well-being” … It was this enlarged will to health that was amplified and instrumentalized by new strategies of advertising and marketing in the rapidly growing consumer market for health (2001, 17-18).

According to Rose, by such developments, ‘selfhood has become intrinsically somatic – ethical practices increasingly take the body as a key site for work on the self’ (18). But he also argues that by linking our well-being to the quality of our individual biology we have not become passive in the face of our biological fate. On the contrary, biological identity has become ‘bound up with more general norms of enterprising, self actualizing, responsible personhood’ (18-19). By considering ourselves responsible for our own biology as key to our health, we have come to depend on ‘professionals of vitality’ (22) whether they be purveyors of DIY devices, genetic counsellors, drug companies or doctors.

With respect to contemporary debates over DIY practices, some have argued that they allow both doctors and patients to be ‘experts’ and call for ‘a relationship of interactive partnership,’ not only because patients today are often informed but also because ideally they know best their own bodies and ailments (Kennedy 2003). Against this idealising assessment, the historical perspective makes us aware that while self-help and self-treatment have been an important dimension of past medical cultures, it appears that historically, patients have not relied as much on a face-to-face empathetic encounter with any one physician as today’s debates suggest. Moreover, today as in the past, the mere existence of markets for medical devices influences how consumers/patients decide whether to resist or embrace the various possibilities of self-treatment as well as their relationships with those who provide it. As Porter has argued, purveyors of ‘alternative’ medicines rationalised their therapeutic effects in ways that differed from official scientific methods and using arguments that likewise changed over time. Depending on the perspective of whose model of evidence users deemed most credible, the co-existence of diverse models for practicing medicine must be assumed throughout history and despite nineteenth-centuries attempts to eliminate unorthodox medicines (Timmermann 2010). The result was a diverse network of fast-changing relationships in which no single one was ascribed the ultimate power to heal. Reflecting on this history, historian of medicine and physician Jeremy Greene has stated that contemporary DIY devices therefore appear ‘neither wholly new nor wholly liberating’ (2016, 308). Our analysis corroborates Greene’s, in that it shows how those who use new DIY technologies may free themselves from their traditional relationship of dependence on physicians, while also creating new relationships with those actors who produce apps or conduct marketing. Yet our study also suggests that there is no one ethical conclusion about whether DIY or physician-dominated care is a better way of living up to a more humane medicine. Ethical arguments and the grounds on which we are supposed to resolve them are complex and variable. As seen in these historical examples, they have changed profoundly over time with each technology and medical concept challenging and refashioning the doctor-patient bond anew. Furthermore, there is no such thing as a ‘timeless’ doctor’s healing presence, or even medical expertise, or an ill person/patient. As shown above, as health and illness are defined, redefined and challenged throughout history, this process creates both expert and patient, as well as shapes the relationship between them.

An oft-heard concern about ‘computerization’ in medicine is that digital objects are changing human interactions. While various representatives from the tech side are optimistic about the effects of increasingly dynamic and intelligent objects in the medical encounter, some patients and physicians are more skeptical and see their social relationships as disturbed by new technologies. ‘Doctors don’t talk to patients’ is the most common complaint the CEO at a Montreal hospital recounted hearing from current patients (conversation between the author and Lawrence Rosenberg, 2019). Fears that increasing digitization of medicine will disturb the relationship that can potentially make the patient ‘whole’ again are not without foundation (King 2020). However, without a clear baseline for assessing changes we have limited scope for drawing conclusions about present day realities or long-term trends. Given the appeal of using the past to suggest a more ‘human’ but lost era of medical practice, a less nostalgic but more sophisticated understanding of the past as provided by historical research would serve us well. In this sense, history can counteract a characteristically modern myopia, namely, as intellectual historian Teresa Bejan has put it, our ‘endearing but frustrating tendency to view every development in public life as if it were happening for the first time’ (2017, 19).

As we saw in the examples dealing with record keeping, examining and self-treatment, trends that consider the patient as an object – a diseased lung, or a malfunctioning heart valve – and the concomitant use of technologies to record, examine and treat physical symptoms were necessarily in tension with patients’ own accounts of how they became ill and of the symptoms they experienced. In fact, concerns about the loss of meaningful personal contact in the medical encounter are incomprehensible without reference to a historical trend dating back to the beginning of the nineteenth century which seems to undermine the patient’s perspective by focusing on increasingly specialised processes within the body. Yet neither before nor after that time is there an unmediated patient’s voice that we are able to recover: the medical record as historical source has its own distinct material history, and patients’ expectations were always bound up with broader societal views about acceptable standards of healing. The historical perspective also shows that we should not take for granted the linear narrative of the technological as adverse to human relations and reducing empathetic understanding in the medical encounter – to paraphrase Lauren Kassell, the digital is not just the enemy of the human (2016, 128). Rather, it makes us aware that our understanding of the doctor-patient relationship and of its role in healing are themselves historically contingent. The idea of ‘a friendly, family doctor “being there”’ and the association of medicine with a ‘desirable clinical relationship’ (as opposed to e.g. perfect health) is an idea that has played out very differently in the course of history (Porter 1999, 670). There were times in which listening to patients was bound up with completely different expectations from both sides, and there were times in which physical examination was not seen as an indispensable part of medical practice. Moreover, while the monopoly of the physician in matters of health care and the focus on the (exclusive) healing potential of the clinical relationship is of relatively recent origin, we have seen that the popularity and economy of DIY devices has a much longer history, one that resists a linear account of DIY devices as something purely liberating. Hence, in contrast to idealised and simplified historical narratives that lament the loss of human relationships, more sophisticated accounts should acknowledge that medical objects and technologies are not the strange and disturbing ‘other’ in the medical encounter but rather integral players therein. As Frank Trentmann has put it, ‘things and humans are inseparably interwoven in mutually constitutive relationships’ (2009, 307). While the authors of a recent study suggest that ‘the traditional dyadic dynamics of the medical encounter has been altered into a triadic relationship by introducing the computer into the examination room’ (Assis-Hassid et al. 2015, 1), it seems more likely that the dyadic relationship has never existed.

Abrams, Ken and Casey Korba. 2018. "Consumers are on Board with Virtual Health Options. Can the Health Care System Deliver?” https://www2.deloitte.com/insights/us/en/industry/health-care/virtual-health-care-consumer-experience-survey.html .

Amenta, Conrad. 2017. “What’s Digitization Doing to Health Care?” Vice . https://motherboard.vice.com/en_us/article/785v3z/whats-digitization-doing-to-health-care.

Amicomed. 2018-2019. San Francisco, CA. https://www.amicomed.us/ .

Anon. 1879. “Practice by Telephone.” The Lancet 2: 819.

Google Scholar  

Anon. 1850. “Proceedings of a Meeting of the Royal Medical and Chirurgical Society on the Use of the Speculum, 28 May 1850, and Relevant Correspondence.” The Lancet 1: 701-06.

Anon. 1887. “The Telephone as a Source of Infection.” British Medical Journal : 166.

Aronson, Sidney H. 1977. “The Lancet on the Telephone 1876-1975.” Medical History 21: 69-87.

Article   Google Scholar  

Assis-Hassid, Shiri, et al. 2015. “Enhancing Patient-Doctor-Computer Communication in Primary Care: Towards Measurement Construction.” Israel Journal of Health Policy Research 4 (4): 1-11. https://doi.org/10.1186/2045-4015-4-4 .

Bartens, Werner. 2019. ”Angehende Ärzte müssen Empathie Zeigen.“ Süddeutsche Zeitung . 31 July. https://www.sueddeutsche.de/gesundheit/medizinstudium-empathie-auswahlverfahren-1.4546284 .

Behrens R., N. Bischoff and C. Zelle, eds. 2012. Der ärztliche Fallbericht. Epistemische Grundlagen und textuelle Strukturen dargestellter Beobachtung . Wiesbaden: Harrassowitz.

Bejan, Teresa M. 2017. Mere Civility: Disagreement and the Limits of Toleration . Harvard: Harvard University Press.

Book   Google Scholar  

Békés, V. and K. Aafjes-van Doorn. 2020. “Psychotherapists’ Attitudes toward Online Therapy during the COVID-19 Pandemic.” Journal of Psychotherapy Integration 30 (2): 238-247. https://doi.org/10.1037/int0000214 .

Beurer HealthManager. 2018-2019. Ulm: Beurer GmbH. https://www.beurer.com/web/gb/ .

Bichat, Xavier. 1801. Anatomie générale, appliquée à la physiologie et à la médecine. Paris: Brosson.

Bijker, Wiebe E., Thomas P. Hughes and Trevor Pinch, eds. 2012 [1987]. The Social Construction of Technological Systems: New Directions in the Sociology and History of Technology . Cambridge: The MIT Press.

Boeldt, D. L. et al. 2015. “How Consumers and Physicians View New Medical Technology: Comparative Survey.” Journal of Medical Internet Research 17 (9): e215. doi: 10.2196/jmir.4456: https://doi.org/10.2196/jmir.4456 .

Bynum, W. F. 2006. “The Rise of Science in Medicine, 1850-1913.” In The Western Medical Tradition, 1800-2000 , edited by W. F. Bynum et al., 111-239. Cambridge: Cambridge University Press.

Canada Health Infoway. 2001-2019. Toronto: Canada Health Infoway. https://www.infoway-inforoute.ca/en/solutions/digital-health-foundation/electronic-medical-records/benefits-of-emrs .

Chauhan, Vivek et al. 2020. “Novel Coronavirus (COVID-19): Leveraging Telemedicine to Optimize Care While Minimizing Exposures and Viral Transmission.” J Emerg Trauma Shock 13 (1): 20–24.

Colombat, de l’Isère, Marc. 1838. Traité des maladies des femmes et de l’hygiène spéciale de leur sexe , vol. 1 Paris: Libraire médicale de labé.

Cooper Owens, Deirdre. 2017. Medical Bondage: Race, Gender, and the Origins of American Gynecology . Atlanta: University of Georgia Press.

Daston, Lorraine J., and Peter Galison. 2010. Objectivity . New York: Zone.

de Looper, Christian. 2019. “The 10 Best Health Apps.” Digital Trends , 5 January. https://www.digitaltrends.com/mobile/best-health-apps/ .

Dinges, Martin, Kay Peter Jankrift, Sabine Schlegelmilch, and Michael Stolberg, eds. 2016. Medical Practice, 1600-1900: Physicians and their Patients . Translated by Margot Saar. Clio Medica, volume 96. Leiden: Brill Rodopi.

Doctor On Demand. 2012-2019. San Francisco, CA. https://www.doctorondemand.com/ .

Ehrlich, Anna. 2007. Ärzte, Bader, Scharlatane. Die Geschichte der österreichischen Medizin . Wien: Amalthea.

Economist, The . “How Covid-19 Unleashed the National Health Service.” 3 December 2020: 55-56. https://www.economist.com/britain/2020/12/03/how-covid-19-unleashed-the-nhs .

Ekeland, Anne G., Alison Bowes, and Signe Flottorp. 2010. “Effectiveness of Telemedicine: A Systematic Review of Reviews.” Int J Med Inform 79:736–771.

Epstein, Julia L. 1986. “Writing the Unspeakable: Fanny Burney's Mastectomy and the Fictive Body.” Representations 16:131–166.

Eysenbach, G. 2007. “From Intermediation to Disintermediation and Apomediation: New Models for Consumers to Access and Assess the Credibility of Health Information in the Age of Web 2.0.” Stud Health Technol Inform 129 (Pt 1): 162-6.

Fagherazzi, Guy. 2020. “Digital Health Strategies to Fight COVID-19 Worldwide: Challenges, Recommendations, and a Call for Papers.” Journal of Medical Internet Research 22 (6): e19284.

Falk, Oliver. 2018. “Der Patient als epistemische Größe. Praktisches Wissen und Selbsttechniken in der Diabetestherapie 1922-1960." Medizinhistorisches Journal 53 (1): 36-58.

Fischer, Claude S. 1992. America Calling: A Social History of the Telephone to 1940 . Berkley: University of California Press.

Fissell, Mary E. 1991. “The Disappearance of the Patient’s Narrative and the Invention of Hospital Medicine.” In British Medicine in an Age of Reform , edited by A. Wear and R. French, 92-109. London: Routledge.

---- 1993. “Innocent and Honorable Bribes: Medical Manners in Eighteenth-Century Britain.” In The Codification of Medical Morality: Historical and Philosophical Studies of the Formalization of Western Medical Morality in the Eighteenth and Nineteenth Centuries . Volume 1: Medical Ethics and Etiquette in the Eighteenth Century , edited by Robert Baker, Dorothy Porter and Roy Porter, 19-46. Dordrect: Springer Science + Business Media.

---- 2012. “The Medical Marketplace, the Patient, and the Absence of Medical Ethics in Early Modern Europe and North America.” In The Cambridge History of World Medical Ethics , edited by Robert Baker and Laurence McCullough, 533-39. Cambridge: Cambridge University Press.

Forrester, John. 1996. “If p, then what? Thinking in Cases.” History of the Human Sciences 9 (3): 1-25.

Friedberg, Mark W. et al. 2013. “Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy.” Santa Monica, CA: RAND Corporation. https://www.rand.org/pubs/research_reports/RR439.html .

Gafner, Lina. 2016. “Administrative and Epistemic Aspects of Medical Practice: Caesar Adolf Bloesch (1804-1863).” In Medical Practice, 1600-1900: Physicians and their Patients , edited by Martin Dinges et al., 253-70. Leiden: Brill Rodopi.

Gawande, Atul. 2018. “Why Doctors Hate Their Computers.” The New Yorker . 12 November. https://www.newyorker.com/magazine/2018/11/12/why-doctors-hate-their-computers .

Granshaw, Linda. 1992. “The Rise of the Modern Hospital in Britain.” In Medicine in Society , edited by Andrew Wear, 197-218. Cambridge: Cambridge University Press.

Chapter   Google Scholar  

Greene, Jeremy. 2016. “Do-it-Yourself Medical Devices: Technology and Empowerment in American Health Care.” New England Journal of Medicine 374:305-9.

Greenhalgh, Trisha et al. 2020. “Video Consultations for Covid-19: An Opportunity in a Crisis?” BMJ , 368: m998. doi: https://doi.org/10.1136/bmj.m998 .

Hammack-Aviran, Catherine M. et al. 2020. “Research Use of Electronic Health Records: Patients’ Views on Alternative Approaches to Permission.” AJOB Empirical Bioethics 11 (3): 172-186. doi: https://doi.org/10.1080/23294515.2020.1755383 .

Heinrich, Christian. 2017. “Treffen im virtuellen Sprechzimmer.“ Die Zeit 22 (24 May): 33. https://www.zeit.de/2017/22/telemedizin-sprechstunde-arzt-krankenkasse-erstattung-video .

Hess, V. and J. Andrew Mendelsohn. 2010. “Case and Series: Medical Knowledge and Paper Technology, 1600–1900.” History of Science 48 (3-4): 287–314. https://doi.org/10.1177/007327531004800302 .

Huerkamp, Claudia. 1989. “Ärzte und Patienten. Zum strukturellen Wandel der Arzt-Patient-Beziehung vom ausgehenden 18. bis zum frühen 20. Jahrhundert.“ In Medizinische Deutungsmacht im sozialen Wandel des 19. und frühen 20. Jahrhunderts , edited by Alfons Labisch und Reinhard Spree, 57-73. Bonn: Psychiatrie-Verlag.

Jewson, Nicholas D. 1976. “The Disappearance of the Sick-Man from Medical Cosmology, 1770-1870.” Sociology 10: 225-44.

Johnston, S. C. 2018. “Anticipating and Training the Physician of the Future: The Importance of Caring in an Age of Artificial Intelligence.” Acad Med 93 (8): 1105-1106. doi: https://doi.org/10.1097/ACM.0000000000002175 .

Kassell, Lauren, 2016. “Paper Technologies, Digital Technologies: Working with Early Modern Medical Records.” In The Edinburgh Companion to the Critical Medical Humanities , edited by S. Atkinson, J. Macnaughton and J. Richards, 120-135. Edinburgh: Edinburgh University Press. http://www.jstor.org/stable/10.3366/j.ctt1bgzddd .

Kay, Michael. 2012. “Give the Doc a Phone: A Historical long-view of Telephone Use and Public Health in Britain.” https://michaelakay.wordpress.com/2012/02/14/give-the-doc-a-phone-a-historical-long-view-of-telephone-use-and-public-health-in-britain/ .

Kennedy, I. 2003. “Patients are Experts in their own Field.” BMJ 326 (7402): 1276-7.

Kennedy, Meegan. 2017. “Technology.” In The Routledge Research Companion to Nineteenth-Century British Literature and Science , edited by John Holms and Sharon Ruston, 3011-328. London: Routledge.

King, Steven and Alan Weaver. 2000. “Lives in Many Hands: The Medical Landscape in Lancashire, 1700-1820.” Medical History 44 (2): 173-200.

King, Martina. 2020. “"Nach Aufnahme arterielle Hypotonie": Personenkonzept und Kommunikationsformen in der Experten-Medizin.” Gesnerus 77 (2): 411-37.

Ko, Y. 2016. “Sebastian Kneipp and the Natural Cure Movement of Germany: Between Naturalism and Modern Medicine.” Uisahak 25(3): 557-590. doi: 10.13081/kjmh.2016.25.557.

Koch, Tom. 2011. Disease Maps: Epidemics on the Ground . Chicago: University of Chicago Press.

Kolkenbrock, Marie. 2020. “The Dance of the Porcupines. On Finding the Balance between Proximity and Distance in Times of Pandemic.” The Hedgehog Review Blog: Critical Reflections on Contemporary Culture . 21 April. https://hedgehogreview.com/blog/thr/posts/the-dance-of-the-porcupines .

Kruse, Clemens S. et al. 2017. “The Effectiveness of Telemedicine in the Management of Chronic Heart Disease: A Systematic Review.” J R Soc Med Open 8 (3): 1–7. doi: https://doi.org/10.1177/2054270416681747 .

Lee, Shaun Wen Huey et al. 2017. “Comparative Effectiveness of Telemedicine Strategies on Type 2 Diabetes Management: A Systematic Review and Network Meta-analysis.” Scientific Reports 7:12680. doi: https://doi.org/10.1038/s41598-017-12987-z .

Lengwiler, Martin, and Jeannette Madarász. 2010. “Präventionsgeschichte als Kulturgeschichte der Gesundheitspolitik.” In Das präventive Selbst: Eine Kulturgeschichte moderner Gesundheitspolitik , edited by Martin Lengwiler and Jeannette Madarász, 11-28. Bielefeld: Transcript.

Liu, Xiaoxuan, Pearse A. Keane and Alastair K Denniston. 2018. “Time to Regenerate: The Doctor in the Age of Artificial Intelligence.” Journal of the Royal Society of Medicine 11 (4): 113-116.

Loder, Natasha. 2017. “Is There a Doctor in my Pocket?” 1843 Magazine, The Economist . https://www.1843magazine.com/technology/is-there-a-doctor-in-my-pocket .

Mathar, Thomas. 2010. Der digitale Patient. Zu den Konsequenzen eines technowissenschaftlichen Gesundheitssystems . Bielefeld: Transcript.

Matshazi, Nqaba. 2019. “Digital Health Funding Breaks New Record in 2018.” 24 January. https://healthcareweekly.com/digital-health-funding/ .

Medgate Tele Clinic. 2000-2019. Basel: Medgate AG. https://www.medgate.ch/ .

Mitchell, Lisa and Eugenia Georges. 2000. “Cross-Cultural Cyborgs: Greek and Canadian Women’s Discourses on Fetal Ultrasound.” In Bodies of Technology: Women’s Involvement with Reproductive Medicine , edited by Ann Rudinow Saetnan, Nelly Oudshoorn, and Marta Kirejczyk, 384-409. Columbus: Ohio State University Press.

Moscucci, Ornella. 1990. The Science of Woman: Gynaecology and Gender in England, 1800–1929 . Cambridge: Cambridge University Press.

Nolte, Karen. 2009. “Vom Verschwinden der Laienperspektive aus der Krankengeschichte: Medizinische Fallberichte im 19. Jahrhundert.” In Zum Fall machen, zum Fall werden. Wissensproduktion und Patientenerfahrung in Medizin und Psychiatrie des 19. und 20. Jahrhunderts , edited by S. Brändli-Blumenbach, B. Lüthi, and G. Spuhler, 33-61. Frankfurt, New York: Campus.

Obermeyer, Ziad, and Ezekiel J. Emanuel. 2016. “Predicting the Future – Big Data, Machine Learning, and Clinical Medicine.” NEJM 375:1216-19.

Peckham, Robert. 2015. “Panic Encabled: Epidemics and the Telegraphic World.” In Empires of Panic: Epidemics and Colonial Anxieties , edited by Robert Peckham, 131-54. Hong Kong: Hong Kong University Press.

Pomata, Gianna. 1998. Contracting a Cure. Patients, Healers and the Law in Early Modern Bologna . Baltimore: Johns Hopkins University Press.

---- 2010. “Sharing Cases: The Observationes in Early Modern Medicine.” Early Science and Medicine 15:193-236.

---- 2014. “The Medical Case Narrative: Distant Reading of an Epistemic Genre.” Literature and Medicine 32 (1): 1-23.

Porsdam, Sebastian Mann, Julian Savulescu, and Barbara J. Sahakian. 2016. “Facilitating the Ethical Use of Health Data for the Benefit of Society: Electronic Health Records, Consent and the Duty of Easy Rescue.” Phil Trans R Soc A 374:20160130. https://doi.org/10.1098/rsta.2016.0130 .

Porter, Roy. 2011 [1995]. “The Eighteenth Century.” In The Western Medical Tradition, 800 BC to AD 1800 , 10th edition, edited by Conrad Lawrence, Michael Neve, Vivian Nutton, Roy Porter, and Andrew Wear, 371-475. Cambridge: Cambridge University Press.

---- 1999. The Greatest Benefit to Mankind. A Medical History of Humanity from Antiquity to the Present . Fontana Press.

Ratanawongsa, Neda et al. 2016. “Association between Clinician Computer Use and Communication with Patients in Safety-Net Clinics.” JAMA Intern Med 176 (1): 125-128. doi: https://doi.org/10.1001/jamainternmed.2015.6186 .

Reiser, Stanley Joel. 1978. Medicine and the Reign of Technology . Cambridge: Cambridge University Press.

---- 2009. Technological Medicine: The Changing World of Doctors and Patients . Cambridge: Cambridge University Press.

Risse, Guenter B. and John Harley Warner. 1992. “Reconstructing Clinical Activities: Patient Records in Medical History.” Social History of Medicine 5 (2): 183-205.

Rose, Nikolas. 2001. “The Politics of Life Itself.” Theory, Culture & Society 18 (6): 1-30.

Rosenberg, Lawrence. 8 May 2019. “Disintermediation.” Presentation given at Workshop: Medicine without Doctors? Disintermediation and Patient Agency . 4 th Workshop in the series on the Impact of Technological Change on the Surgical Profession. Jewish General Hospital, Montreal.

Ruckstuhl, Brigitte and Elisabeth Ryter. 2017. Von der Seuchenpolizei zu Public Health. Öffentliche Gesundheit in der Schweiz seit 1750 . Chronos: Zurich.

Ritzmann, Iris. 2013. “Vom gemessenen zum angemessenen Körper. Human Enhancement als historischer Prozess.” Schweizerische Ärztezeitung 94 (11): 410-22.

---- 1999. “Der Verhaltenskodex des “Savoir faire” als Deckmantel ärztlicher Hilflosigkeit? Ein Beitrag zur Arzt-Patient-Beziehung im 18. Jahrhundert.” Gesnerus 56:197-219.

Russey, Cathy. 2019. “Healthcare Wearables are Becoming Important for Staying Alive.” 15 January. https://www.wearable-technologies.com/2019/01/healthcare-wearables-are-becoming-important-for-staying-alive/ .

Sandelowski, Margarete. 2000. “This Most Dangerous Instrument: Propriety, Power, and the Vaginal Speculum”. Journal of Obstetric, Gynecologic & Neonatal Nursing 29 (1): 73-82.

Sanders, R. 2003. “Medical Technology: A Critical Perspective.” The Internet Journal of Medical Technology 2 (1): 1-7. https://print.ispub.com/api/0/ispub-article/4943 .

Schmiedebach, Heinz-Peter, ed. 2018. Medizin und öffentliche Gesundheit: Konzepte, Akteure, Perspektiven . Oldenbourg: De Gruyter.

Sinsky, Christine et al. 2016. “Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties.” Annals of Internal Medicine 165 (11): 753-760.

Sobral, Dilermando, Marcy Rosenbaum, and Margarida Figueiredo-Braga. 2015. “Computer Use in Primary Care and Patient-Physician Communication.” Patient Education and Counseling 98 (12): 1568-76.

Strehle, E. M. and N. Shabde. 2006. “One Hundred Years of Telemedicine: Does this new Technology have a place in Paediatrics?” Archives of Disease in Childhood 91:956-959.

“The Topol Review: Preparing the Healthcare Workforce to Deliver the Digital Future. An Independent Report on Behalf of the Secretary of State for Health and Social Care.” 2019. Published by Health Education England. https://topol.hee.nhs.uk/ .

Timmermann, Carsten. 2010. “Risikofaktoren: Der scheinbar unaufhaltsame Erfolg eines Ansatzes aus der amerikanischen Epidemiologie in der deutschen Nachkriegszeit.” In Das präventive Selbst: Eine Kulturgeschichte moderner Gesundheitspolitik , edited by Martin Lengwiler and Jeannette Madarász, 251-277. Bielefeld: Transcript.

Timmermann, Carsten, and Julie Anderson, eds. 2006. Devices and Designs. Medical Technologies in Historical Perspective . London: Palgrave MacMillan.

Toombs, S. Kay. 1992. The Meaning of Illness: A Phenomenological Account of the Different Perspectives of Physician and Patient . Dordrecht: Springer-Science+Busniess Media.

Topol, Eric J., Steven R. Steinhubl, and Ali Torkamani. 2015. “Digital Medical Tools and Sensors.” JAMA 313 (4): 353-354.

Trentmann, Frank. 2009. “Materiality in the Future of History: Things, Practices, and Politics.” Journal of British Studies 48 (29): 283-307.

U.S. Food and Drug Administration. ca. 1995-2019. Silver Spring: U.S. Food and Drug Administration; U.S. Department of Health and Human Services. https://www.fda.gov/medical-devices/digital-health#mobileapp .

Verbeek, Peter-Paul. 2015. “Beyond Interaction: A Short Introduction to Mediation Theory.” Interactions 22 (3): 26-31.

Verghese, Abraham. 2017. “What this Computer needs is a Physician: Humanism and Artificial Intelligence.” JAMA 319 (1): 19-20.

Warner, John Harley. 1999. “The Uses of Patient Records by Historians: Patterns, Possibilities and Perplexities.” Health and History 1 (2/3): 101-11

Weindling, Paul. 1987. “Medical Practice in Imperial Berlin: The Casebook of Alfred Grotjahn.” Bulletin of the History of Medicine 61 (3): 391-410.

Wolff, Eberhard. 2014. “Über das Blutdruckmessen, einen Selbstversuch und ärztliches Alltagshandeln.” Schweizerische Ärztezeitung 95(11): 460. https://www.zora.uzh.ch/id/eprint/107023/1/saez-02492.pdf .

---- 2018. “Das ʻQuantified Selfʼ als historischer Prozess. Die Blutdruck-Selbstmessung seit dem frühen 20. Jahrhundert zwischen Fremdführung und Selbstverortung.” Medizin, Gesellschaft und Geschichte 36:43-83.

World Health Organization. 2016. “Global Diffusion of eHealth: Making Universal Health Coverage Achievable.” Report of the third global survey on eHealth. Geneva: WHO Document Production Services. https://apps.who.int/iris/handle/10665/252529 .

Wüstholz, Florian, and Daniel Stolle. 2020. “Das kranke Dossier.” Republik . 27 July. https://www.republik.ch/2020/07/27/das-kranke-dossier .

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1 We rely on a definition used by science and technology scholars whereby the term ‘technology’ operates on three levels (see Bijker, Hughes and Pinch 2012, xlii). First, there is the physical level, referring to tangible objects such as a smartphone, wellness band, or stethoscope. The second level of meaning concerns activities or processes, such as 3D printing or creating X-rays. The third level refers to knowledge people have in addition to what they do, for example the knowledge that underpins the conduct of a surgical procedure. This approach shows the extent to which specific tools and techniques, knowledge, and rationales for intervention are intricately bound together. Our use of the term ‘digital,’ that is involving computer technology, in relation to medicine ‘includes categories such as mobile health (mHealth), health information technology (IT), wearable devices, telehealth and telemedicine, and personalized medicine’ (U.S. Food and Drug Administration).

2 As a rule, while systematic reviews of telemedicine generally portray it as effective as in-person consultation or promising, evidence is limited and fast-evolving (Ekeland, Bowes and Flottorp 2010; Kruse et al. 2017; Lee et al. 2017).

3 In Germany, legislators have reacted to these concerns by limiting video consultation to cases in which physician and patient have physically met before, and primarily using it for monitoring the course of disease, including chronic ones, or the healing of an injury (Heinrich 2017).

4 Scottish-born US inventor Alexander Graham Bell was the first to be awarded the U.S. patent for the invention of the telephone in 1876 (Fischer 1992).

5 Interestingly, and probably most important for their users, nine out of ten among the ranked apps are available as free downloads ( https://www.digitaltrends.com/mobile/best-health-apps/ , June 16, 2019).

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Rampton, V., Böhmer, M. & Winkler, A. Medical Technologies Past and Present: How History Helps to Understand the Digital Era. J Med Humanit 43 , 343–364 (2022). https://doi.org/10.1007/s10912-021-09699-x

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There is no doubt that technology has changed every aspect of our lives. From the moment we wake up in the morning with our alarms, how we communicate with each other, how we buy the much-needed ingredient for our recipe to the way we travel, technology had made an impact in each of these aspects. Technological advancements have made things easier for all of us and one field that had greatly benefitted from the benefits brought by technology is the medical field.

In the past 200 years, advancements in the medical field have helped cure and save many lives from all around the world. Here is the list of the reasons how important technological advancements are in the medical field.

Advantages brought by technology in the medical field

First of all, medical advancements will not be possible without proper research done by medical scientists and physicians. With the use of technology, researchers are now able to properly search and test new and more effective procedures that can help diagnose, prevent, and cure all kinds of diseases.

Scientists are now able to look at the diseases on a cellular level which helps them look and produce the most effective antibodies against these diseases.

Technology had also enabled the production of new and innovative equipment that helps the physicians diagnose properly the health status of a patient and see into the body of the patient without surgical operations such as the computerized tomography (CT) scans, ultrasound imaging, and x-ray machines. Technology had also paved the way for more innovative equipment that can prevent and cure different kinds of diseases with less or even without pain which is extremely beneficial to patients who are already suffering enough pain from the effects of their diseases.

One of the most significant contributions made by technology in not only our daily lives but also in the medical field is information technology.

Today, we depend on electronic records for easier and better handling of important documents, and the medical field also uses computers to save all records of their patients. With this, doctors can access any information they need on their patients whenever they need it with just a few clicks.

With the use of the internet, researchers can also access all references that they need. Easier communication is another essential product brought by technology. Now, doctors and patients who are separated by great distances can easily talk to each other through video conferences or other methods.

With the use of the internet, patients can also look for alternative treatments that they can do anytime and anywhere they like or need as long as they have an internet connection. Another advantage brought by technology is the ability to reach more patients through social media.

Bottom Line

Technology had truly brought so many advantages in the medical field: advantages that we are benefitting from now. Without the innovations available now, there would be more people who will be prone to the many diseases present as well as many people who will never be able to recover from their illnesses.

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• Published: 28 August 2024

Global trends and hotspots in the study of the effects of PM2.5 on ischemic stroke

• Qian Liu 1 , 2 ,
• Shijie Yang 3 &
• HeCheng Chen 1 , 2  

Journal of Health, Population and Nutrition volume  43 , Article number:  133 ( 2024 ) Cite this article

Metrics details

The objective of this study was to visually analyse global research trends and hotspots regarding the role of PM2.5 in ischemic stroke.

The Web of Science core collection database was used to search the literature on PM2.5 and ischemic stroke from 2006 to 2024. Visualization analysis was conducted using CiteSpace, VOSviewer, and an online bibliometric platform.

The analysis comprises 190 articles published between 2006 and 2024 by 1229 authors from 435 institutions in 39 countries, across 78 journals. Wellenius GA has the highest number of published and cited papers. China has the highest number of papers, while Canada has the highest citation frequency. Capital Medical University published the highest number of papers, and Harvard University had the highest citation frequency for a single paper. The study investigated the impact of PM2.5 on ischemic stroke in three phases. The first phase analysed hospitalisation rates for correlations. The second phase utilised large-scale multi-cohort data from around the world. The third phase involved studying global exposure risk through machine learning and model construction. Currently, there is limited research on the mechanisms involved, and further in-depth investigation is required.

This paper presents a bibliometric analysis of the research framework and hotspots concerning the effect of PM2.5 on ischemic stroke. The analysis aims to provide a comprehensive understanding of this field for researchers. It is expected that research on the effect of PM2.5 on ischemic stroke will remain an important research topic in the future.

Introduction

Ischemic stroke is the leading cause of death and disability worldwide, posing a great threat to human health [ 1 ]. Air pollution is an individual risk factor for ischemic stroke independent of smoking, poor diet, and physical inactivity in the United States. Air pollution accounts for more than a quarter of the stroke burden. [ 2 ]. Airborne fine particulate matter (PM2.5, aerodynamic diameter < 2.5 μm) is the main component of air pollution. At present, a large number of studies have shown that air pollution are highly associated with an increased risk of ischemic stroke, especially PM2.5 [ 3 , 4 , 5 ]. Gu et al. found that for every 10 µg/ m 3 increase in the PM2.5 level in China, hospitalizations for acute cerebrovascular disease and Transient Ischemic Attacks increased by 0.20% and 0.33%, respectively [ 6 ]. Therefore, reducing air pollution and improving air quality are of great significance for reducing the incidence of ischemic stroke.

Bibliometric analysis is a widely used method for evaluating the quality and impact of academic research in various fields [ 7 , 8 , 9 , 10 ]. It presents the knowledge structure and research status of a field more intuitively through quantitative analysis of published literature, making it a faster and more accurate way to study trends and hotspots compared to systematic and wide-ranging reviews and other types of literature research. [ 11 , 12 , 13 ].

Research on the impact of global air pollution on human health has led to a gradual deepening of our understanding of the effect of air pollution on stroke. Specifically, research on the impact of PM2.5 on ischemic stroke has been ongoing for decades, resulting in significant developments and high-quality research results. To date, no bibliometric study has been conducted on the impact of PM2.5 on ischemic stroke to explore the distribution characteristics and trends in this research field. Therefore, this study aims to bibliometrically the relevant literature on the effect of PM2.5 on ischemic stroke, explore the current hotspots and possible future trends in this research field, identify potential research gaps, and provide an important reference for researchers and institutions in this field.

Materials and methods

Data sources and search strategy.

The Web of Science (WOS) is an extensive, multidisciplinary database encompassing all high-impact scientific journals and distinguished indexes [ 14 , 15 , 16 ]. In comparison with Scopus or MEDLINE/PubMed, the literature measurement analysis facilitated by the WOS database can retrieve more comprehensive information [ 17 ]. A literature search using the Web Science Core (WoSCC) database on February 18, 2024. The articles were retrieved from January 1, 2000, to February 18, 2024.The search strategy employed was as follows:

(((((((((((((((((((((((TS=(Ischemic Strokes)) OR TS=(Stroke, Ischemic)) OR TS=(Ischaemic Stroke)) OR TS=(Ischaemic Strokes)) OR TS=(Stroke, Ischaemic)) OR TS=(Cryptogenic Ischemic Stroke)) OR TS=(Cryptogenic Ischemic Strokes)) OR TS=(Ischemic Stroke, Cryptogenic)) OR TS=(Stroke, Cryptogenic Ischemic)) OR TS=(Cryptogenic Stroke)) OR TS=(Cryptogenic Strokes)) OR TS=(Stroke, Cryptogenic)) OR TS=(Cryptogenic Embolism Stroke)) OR TS=(Cryptogenic Embolism Strokes))OR TS=(Embolism Stroke, Cryptogenic)) OR TS=(Stroke, Cryptogenic Embolism)) OR TS=(Wake-up Stroke)) OR TS=(Stroke, Wake-up)) OR TS=(Wake up Stroke)) OR TS=(Wake-up Strokes)) OR TS=(Acute Ischemic Stroke)) OR TS=(Acute Ischemic Strokes)) OR TS=(Ischemic Stroke, Acute)) OR TS=(Stroke, Acute Ischemic)

Step 1 AND Step 2, NOT TI = (“guideline” or “recommendation” or “consensus” or “case report” or “meta” or “review”), AND Language = English. A total of 308 relevant articles were searched.

After conducting an initial data search, two authors screened all manuscripts. Any discrepancies identified by the authors were then independently screened by a third author to ensure their relevance to the topic of this study. A total of 190 documents were retrieved and exported as ‘full records and citation references’ and ‘tabs separate files’ for further analysis.

Data analysis

The bibliometrics used in this study mainly include evaluation techniques and relational techniques [ 18 ]. Evaluation techniques are employed to assess the productivity and impact of scientific papers. These include the number of publications, which is used to assess productivity [ 19 ]; the number of citations, which is used to measure the impact of publications [ 20 ]; the h-index [ 21 ], which is used to measure the number of citations to “h” papers; the g-index, which is used to identify the largest number such that the top g articles receive at least g2 citations [ 22 ]; and the m-index, which takes into account the number of years since the article was published [ 23 ]. These techniques have been employed in the analysis of the PM2.5 effect on ischemic stroke, which has been conducted in collaboration with the most prolific authors and journals in this field. Concurrently, relational techniques are employed to investigate the co-occurrence of keywords and the co-citation of journals, with the generation of a visual graph. The term “co-citation” is used to describe the practice of multiple articles being cited jointly. The outcome of a keyword co-occurrence analysis is a network of topics and their interconnections. The content of a document is examined through the lens of a specific word, which can shed light on the relationship between concepts within a given field [ 24 ]. The higher the frequency of words, the stronger the conceptual connections [ 25 ].

The data in “tabs separate files” were imported into the bibliometric online analysis platform ( http://bibliometric.com ) to analyze the relationship between the collaborating countries/regions. CiteSpace [ 26 ] and VOSviewer [ 27 ], the two most commonly used visual tools analysis software in bibliometrics are mainly used to observe research hotspots and trends in a certain field and visualize them in graphical form [ 27 , 28 ]. We applied CiteSpace (version 6.2.R4) and VOSviewer (version 1.6.20) software to visualize bibliometric data. Imported in “full record and citation reference” format and collaborated on the filtered literature between countries/regions, co-authored and co-citation, co-occurrence, clustering and burst analysis. The PRISMA flowchart illustrates the methodology employed in this study, delineating the procedures undertaken for data acquisition, cleaning, and inclusion (Fig.  1 ) [ 23 , 29 ].

PRISMA flowchart

Following a rigorous process of literature cleaning, inclusion, and exclusion, a total of 308 literature sources were downloaded. These sources were then filtered to exclude early access literature, correction literature, editorial materials, conference abstracts, and conference proceedings. The final number of literature sources included for analysis was 190. The literature spanned the period from 2006 to 2024 and included 78 journals, 1229 authors, 435 institutions, and 39 countries. There were 5775 references cited.

Publication review

Publication numbers.

The top 5 by number of publications by author, country, institution and journal, as well as by citations, are summarised in Table  1 . The top author by the number of publications and citations was Wellenius GA, with 8 publications and an average annual citation number of 88.875; this author focuses on the effect of duration of PM2.5 exposure on ischemic stroke and the relationship between air pollution exposure and ischemic stroke risk in women. The country with the most published studies was China with 106 publications and an average annual citation number of 37.831. Articles from the United States had the highest total number of citations and articles from Canada had the highest average number of citations at 106.077. Capital Medical University published the most articles, with a total of 16 articles, and the average citation of each article was 14.062. Harvard University had the highest average citations per article, which was 282.714. The Table  2 shows that the United States Department of Health and Human Services sponsored the highest number of articles in terms of funding sources. SCIENCE OF THE TOTAL ENVIRONMENT published the most articles, but the average single citation of ENVIRONMENTAL POLLUTION was the highest, which was 54.818.

Number of publications varies by year

By analyzing the number of papers published in a particular research field over the years and the countries in which they were published, we can determine the past development history of this field and the global attention to this field, and also predict the development prospects of this field.

The earliest study of PM2.5 on ischemic stroke was published by Paul J Villeneuve et al. in 2006 [ 30 ], and the number of publications has not increased significantly since then. A clear cut-off point was observed in 2014, and the number of published papers increased significantly thereafter (Fig.  2 ). The participation of countries and regions was an important factor affecting the number of papers published, and much of the contribution during this period was high-quality case-crossover analysis. In 2014, scholars in Taiwan published the first study on the effect of regional PM2.5 levels on ischemic stroke. Since then, the number of regional cooperation and broader studies has increased significantly. Subsequently, the length of PM2.5 exposure period, source methods, and different production scenarios were studied from multiple perspectives. The number of publications peaked in 2022. Therefore, the increase of multi-regional, multi-angle, multi-level research ideas and cooperation and exchange has greatly promoted the development of this research field.

Number of national publications per year

Inter-state cooperation

The United States had a large contribution to PM2.5 research. Four of the top five funding agencies were from the United States. Although the number of articles published in the United States was not the largest, the single cited number was the highest. Since 2013, China’s contribution to this field has become increasingly prominent, with the largest number of articles published in this field, and the National Natural Science Foundation of China has also funded the largest number of research projects in this field (Table  2 ). As a country with a large population and deeply affected by PM2.5, China has an extremely high prevalence of ischemic stroke. It has invested huge in this field and made outstanding contributions. It is believed that China will make greater contributions in this field in the future. China and the United States also have the most cooperation and exchanges in this field (Figure 3 ). The latest research results published by Wellenius GA in 2024 are cooperated with Chinese scholars [ 31 ], and there are many more such cooperation and exchanges.

Cooperation between countries

Distribution of citations between journals

The Dual-Map Overlay shows the distribution of citation relationships between journals (Fig.  4 ). The citing literature is on the left side of the graph, and the cited literature is on the right side of the graph. The colored path between the two represents the citation relationship. Two main citation pathways were found, indicating that studies published in veterinary, animal and natural sciences were mainly cited by studies published in environmental sciences, toxicology and nutrition. Studies published in neurology, kinesiology, and ophthalmology journals are primarily cited by studies published in health, nursing, and medical journals.

Dual-Map Overlay

Top 5 cited articles

The top 5 cited articles included 1 Meta-analysis articles and 4 clinical articles (Table  3 ). Publication dates ranged from 2011 to 2020. The article with the highest number of citations, entitled “An Integrated Risk Function for Estimating the Global Burden of Disease Attributable to Ambient Fine Particulate Matter Exposure”, was published by Burnett, Richard T et al. in 2014 in ENVIRONMENTAL HEALTH PERSPECTIVES , with a total of 1272 citations. Available relative risk information from studies of ambient air pollution (AAP), second-hand tobacco smoke, household solid cooking fuels and active smoking (AS) was integrated to fitted the integrated exposure response (IER) model, which estimated the combined risks of exposure to multi-source PM2.5 [ 32 ]. The second and fifth cited articles are the studies on the risk of PM2.5 exposure published by Shah AS et al. and Lipsett MJ et al. These studies elucidate the risk of PM2.5 exposure in two distinct aspects: short-term exposure and long-term exposure, respectively [ 33 , 34 ]. Air pollution in China remains a significant concern, with a considerable body of scholarship dedicated to understanding the impact of PM2.5 on public health. A review of the literature reveals that the third and fourth most-cited articles pertain to the disease burden associated with PM2.5 in China [ 35 , 36 ].

Co-citation analysis

Author co-citation network analysis.

Lotka’s law was used to determine the minimum number of co-citations. [ 37 ]. Fifty-seven authors met the criteria, with Pope Ca, Wellenius GA, and Tian YH being the top three co-cited authors. The authors were divided into three clusters (Fig.  5 ).

Co-citation author analysis Red : cluster1; Green : cluster2; Blue : cluster3

Professor Pope Ca from Brigham Young University has conducted comprehensive research on the multifaceted, multi-regional, and multi-level impact of PM2.5 on disease. His team has made a substantial contribution to the assessment of the global burden of disease caused by fine particulate matter. Wellenius, a professor at Boston University, has been engaged in research in the field of environmental and health sciences for an extended period. His contributions to the field include a significant impact on the understanding of the influence of PM2.5 on cardiovascular and cerebrovascular disease. His research has been based on a thorough examination of the local area of PM2.5, the duration of exposure, and the factors influencing the PM2.5 exposure. Professor Tian YH of Beijing University has conducted extensive research on the impact of PM2.5 in China. His studies have covered a vast area, encompassing up to 184 cities, and have focused on the effects of PM2.5 on ischemic cerebral apoplexy. The findings have been used to inform national policy.

Journals co-citation network analysis

If at least one article from both journals is cited in the cited article, two journals are considered to be cited simultaneously [ 38 ]. Seventy journals met the criteria, with ENVIRONMENTAL HEALTH PERSPECTIVES , STROKE , and ENVIRONMENT INTERNATIONAL being the top three cited journals (Fig.  6 ). The total number of citations for ENVIRONMENTAL HEALTH PERSPECTIVES was high, and the average number of citations per article was as high as 211.14.

Co-citation Jour analysis Red : cluster1; Green : cluster2; Blue : cluster3

Literature co-citation network analysis

Literature were cited analysis is a widely used to study the knowledge in certain areas framework method [ 39 ]. Figure  7 shows the literature co-citation network in the field of PM2.5 effect on ischemic stroke. In the figure, a node represents a document/article, while the connecting line between the two nodes represents the co-cited association between the two articles. The larger the node, the more citations an article has. The smaller the distance between two nodes, the higher the citation frequency of the literature.

Co-citation reference analysis Red : cluster1; Green : cluster2; Blue : cluster3

There were 24 literatures that met the criteria (Fig.  7 ), and the top 3 cited references were Brook Robert D et al. 2010, Wellenius GA et al. 2012, and Wellenius GA et al. 2005. Brook Robert D et al. conducted a review of the effects of particulate air pollution on cardiovascular disease and concluded that the longer the exposure to PM2.5, the greater the risk of cardiovascular mortality and that lower levels of PM2.5 were associated with lower cardiovascular mortality [ 40 ]. Wellenius GA et al. found that exposure to PM2.5, a level considered generally safe by the US Environmental Protection Agency’s, increased the risk of ischemic stroke within hours of exposure. This means that lower levels of PM2.5 are not safe [ 41 ]. Wellenius GA et al. in 2005 found that PM2.5 levels increased the risk of ischemic but not hemorrhagic stroke [ 42 ]. The above three articles reached the same conclusion from different perspectives: exposure to PM2.5 may increase the risk of ischemic stroke. This provides a solid basis for further research.

Co-occurrence network and analysis of keywords

According to Lotka’s law, 88 keywords were included in the co-occurrence network analysis (Fig.  8 ). The co-occurrence network was divided into 6 clusters. A total of 10 bursts were identified, with the highest intensity being ‘hospital admissions’ (strength, 4.27), followed by ‘global burden’ (strength, 4.14). The last burst was “PM2.5” (strength, 3.89; Fig.  9 ). In order to better analyse the annual research hotspots and the overall trend of change in the research area, citespace was used to perform a timezone analysis of the keywords (Fig.  10 ). The whole graph was divided into several vertical blocks from 2006 to 2024, with an interval of one year. Each block had several nodes, and each node represented a keyword. The nodes are composed of one or more colours, and each colour represents a year. The colour in the outer circle of the node represents the closest to the present, and the width of the colour represents the popularity of the year. If the node is all red, it represents the central hot word. The connection between the nodes represents the connection between two keywords. As you can see from the figure, the study of PM2.5 and ischemic stroke only started in 2006, less than 20 years ago. From 2006 to 2008, a large number of studies on air pollution, ischemic stroke, cardiovascular disease, hospital admissions and exposure were carried out in this area and continue to this day. In 2022, PM2.5 became a central buzzword in the field. From 2011 to 2014, this field focused on the global health burden of PM2.5, using a large number of case-crossover analysis methods, and a large number of Chinese scholars began to pay attention to this field. From 2016 to 2018, this field began to focus on national and regional research, and there were a large number of studies on the effect of PM2.5 on ischemic stroke in China. At the same time, since 2016, this area has received more and more attention, reaching a peak in 2023. From 2018, more in-depth research will be conducted on PM2.5 as a risk factor, and attention to this area will become more popular. By 28 February 2024, the number of research articles in 2024 will have reached the level of the whole year 2014. Research on the effect of PM2.5 on ischemic stroke is expected to show an increasing trend in the future.

Co-Occurrence of key words Red : cluster1; Green : cluster2; Blue : cluster3; Yellow : cluster4; Purple: cluster5; Light blue: cluster6

Key words with the strongest citation bursts

Timezone of key words

Bibliometrics can help people understand the research focus, framework and trend of a certain field intuitively and comprehensively. PM2.5 has been widely studied as a risk factor for ischemic stroke, and reducing the level of PM2.5 can effectively reduce the occurrence of ischemic stroke. A summary of previous studies in this field has occasionally been reported, but there has been no bibliometric description of the literature in this field.

A bibliometric analysis of the study found that the most published author was Wellenius GA, who is affiliated with the Department of Environmental Health at the Boston University School of Public Health. The most cited article is a study by Burnett, Richard T et al., on risk estimation models for PM2.5 exposure. The research integrates the relative risk (RR) information of PM2.5 from different global scenarios and sources of different combustion types to construct and fit a sustainable and updated comprehensive exposure-response model, which can provide important reference for the regulation of PM2.5 32 . Air pollution from PM2.5 is a global problem that has caused a global health burden. In the early stage, almost all the studies on PM2.5 came from developed countries such as Europe and the United States. However, the worst affected areas of PM2.5 pollution are mainly in developing countries. However, the research in this field from developing countries starts very late, and there is a lack of primary epidemiological investigation. From Fig.  2 , we can find that the first study on China was reported in 2013, which was a study published by scholars in Taiwan on the relationship between PM2.5 level and hospitalization rate of ischemic stroke in Taipei City, Taiwan Province [ 43 ]. The initial study in this field was published in mainland China in 2014, although it was a Meta analysis [ 44 ]. This indicated that mainland China was also beginning to focus on the field. In India, another large developing country, the first study on PM2.5 within the country was not published until 2016 [ 45 ]. Furthermore, Burnett et al. not only included global PM2.5 data from various areas but also considered different sources of PM2.5 production, such as smoking, second-hand smoke, and household fuels. These sources are prevalent in daily life, which enhances the generalisation and wide application of the study’s conclusions. This also better illustrates the global PM2.5 exposure risk worldwide. At that time, the study by Burnett, Richard T et al. made a significant contribution to the global PM2.5 exposure problem and was undoubtedly a major achievement. A global integrated exposure-response risk assessment has been applied similarly, providing a crucial reference for policymakers in the field of global climate policy [ 46 , 47 , 48 ].

Co-citation analysis offers valuable insights into the structural characteristics of a research area. The authors were divided into three clusters based on their citations. Cluster 1 authors focused on studying the impact of PM2.5 levels on the risk of ischemic stroke in various regions of the world. Cluster 2 authors conducted a study on the relationship between PM2.5 levels and ischemic stroke risk in various regions of China. These researches included multiple perspectives on different exposure periods, surrounding environments, and different subtypes of ischemic stroke. Chen Gongbo et al. [ 49 ], Liang, Ruiming et al. [ 50 ] and Zhang, Yi et al. [ 51 ] conducted studies on the effects of long-term and short-term exposure to PM2.5 on the risk of ischemic stroke. They concluded that PM2.5 is associated with a high risk of ischemic stroke, regardless of the duration of exposure. Furthermore, studies have been conducted on the various components of PM2.5. Zhang et al. [ 51 ] discovered that exposure to NH4 + was linked to the highest risk of ischemic stroke, while polycyclic aromatic hydrocarbons (PHS) were primarily associated with ischemic stroke. NH4 + originated mainly from residential and agricultural emissions, while PHS mainly came from automobiles and other related fuel combustion [ 52 , 53 ]. Many of these studies are based on large, multi-city samples, Tian Y et al. conducted a study based on data from the National Urban Workers’ Basic Medical Insurance database, which recorded 8,834,533 patients hospitalized for cardiovascular reasons in 184 cities in China from 1 January 2014 to 31 December 2017. The study found that short-term exposure to PM2.5 was associated with increased hospital admissions for all major cardiovascular diseases except hemorrhagic stroke in China. This association was observed even when exposure levels did not exceed current regulatory limit [ 54 ], Cai M et al. found that exposure to PM2.5 was highly associated with a high risk of ischemic stroke recurrence in China, based on data from more than 1 million stroke patients [ 55 ]. The authors of Cluster 3 focus on risk assessment and model construction related to PM2.5. This provides a reference for preventing and treating PM2.5 exposure in the future.

The top 3 cited references were Brook Robert D et al. 2010 [ 40 ], Wellenius GA et al. 2012 [ 41 ], and Wellenius GA et al. 2005 [ 42 ]. The papers represent early and pioneering research in the field, providing a solid theoretical foundation for subsequent studies. The journals in which they were published are of high quality and widely accepted by researchers. The authors are also leading scientists in the field, and their research results are significantly forward-looking and instructive. The co-cited articles were divided into three categories. Cluster 1 was constructed around Wellenius GA et al. 2012 and Wellenius GA et al. 2005. These studies mainly demonstrated that PM2.5 contributes to the risk of ischemic stroke. Cluster 2 was constructed around Brook Robert D et al. In 2010, multiple cohorts and large sample data further confirmed that PM2.5 increases the risk of ischemic stroke. Cluster 3, as analysed by Tian Yh et al. in 2018, provides insight into the development trend and pattern of ischemic stroke caused by PM2.5 from a time series perspective.

To gain a better understanding of the dynamic developmental changes and patterns in the field, this study utilized Citespace for burst word analysis and Timezone analysis. The findings indicate that between 2006–2016, the field primarily focused on the relationship between air pollution and hospital admissions. The study found that air pollution significantly affected cardiovascular disease admissions, and when ischemic stroke was included in the study of cardiovascular disease. Between 2013 and 2017, researchers increasingly focused on the significant role of particulate matter in air pollution, including the effect of PM2.5 levels on ischemic stroke. The buzzwords during this period were ‘hospital admissions’ and ‘cardiovascular disease’. Between 2017 and 2020, scholars in the field shifted their focus towards the worldwide impact of air pollution. This period also saw a significant increase in the number of articles published in the field, with many developing countries joining the research efforts. The term ‘global burden’ was coined to describe this phenomenon. Since then, researchers have subdivided air pollution into different types, with PM2.5 receiving significant attention as a risk factor. This focus began with the explosion in 2022, which saw a peak in publications on the topic. In recent years, advancements in research methods have enabled researchers to conduct large-scale exposure risk assessments around the world regarding PM2.5 as a risk factor. This has provided valuable insights for the development of global climate policies. Therefore, the key terms for 2020–2024 are “PM2.5”, “risk factor”, and “modelling”.

This bibliometric study examines the impact of PM2.5 on ischemic stroke and serves as a valuable reference for those interested in this field. However, there are some limitations to consider. Firstly, the study only includes research articles, excluding conferences, letters, and articles in non-English languages, which limits the scope of the articles included. Secondly, the search was restricted to the WoSCC database. The WoSCC database covers most research articles, but it is challenging to guarantee the inclusion of all articles in the field. Despite these limitations, they do not affect the broad applicability of the findings of this study. The analyses are based on real-world data, and the results are reliable. They reflect the structural characteristics and dynamics of the field and are valuable for a comprehensive understanding of the field. Additionally, they are highly informative for the study of future trends in the field. There is a significant amount of high-quality evidence from clinical studies, epidemiological investigations, and large-sample model construction regarding the effect of PM2.5 on ischemic stroke. However, the mechanism behind this effect remains unclear and requires further research in the future.

The study of the effects of PM2.5 on ischemic stroke is a relevant and attractive field. Environmentalists, neurologists, and other professionals will continue to advance this field. In recent years, the addition of computationalists and meteorologists has led to the development of models and the use of meteorological satellite remote sensing. Bibliometrics analyses the research framework and hotspots of PM2.5’s impact on ischemic stroke, which is a significant driver of ischemic stroke. The model construction, based on large samples and multiple cohorts, effectively assessed the global exposure risk of PM2.5. This provides an important reference for the development of global climate change response strategies and helps researchers to have a more comprehensive understanding of the field, providing ideas for future research.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

Airborne fine particulate matter aerodynamic diameter < 2.5 μm

Web Science Core

Polycyclic aromatic hydrocarbons

Global burden of 369. diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. Oct 17 2020;396(10258):1204–1222. https://doi.org/10.1016/s0140-6736(20)30925-9

Feigin VL, Roth GA, Naghavi M, et al. Global burden of stroke and risk factors in 188 countries, during 1990–2013: a systematic analysis for the global burden of Disease Study 2013. Lancet Neurol Aug. 2016;15(9):913–24. https://doi.org/10.1016/s1474-4422(16)30073-4 .

Article   Google Scholar  

Li P, Wang Y, Tian D, et al. Joint exposure to Ambient Air pollutants, genetic risk, and ischemic stroke: a prospective analysis in UK Biobank. Stroke Feb. 2024;1. https://doi.org/10.1161/strokeaha.123.044935 .

Gao L, Qin JX, Shi JQ, et al. Fine particulate matter exposure aggravates ischemic injury via NLRP3 inflammasome activation and pyroptosis. CNS Neurosci Ther Jul. 2022;28(7):1045–58. https://doi.org/10.1111/cns.13837 .

Article   CAS   Google Scholar  

Sterpetti AV, Marzo LD, Sapienza P, Borrelli V, Cutti S, Bozzani A. Reduced atmospheric levels of PM2.5 and decreased admissions and surgery for ischemic stroke in Italy. J Stroke Cerebrovasc Dis Mar. 2024;33(3):107504. https://doi.org/10.1016/j.jstrokecerebrovasdis.2023.107504 .

Gu J, Shi Y, Zhu Y, et al. Ambient air pollution and cause-specific risk of hospital admission in China: a nationwide time-series study. PLoS Med Aug. 2020;17(8):e1003188. https://doi.org/10.1371/journal.pmed.1003188 .

Coll-Ramis MÀ, Horrach-Rosselló P, Genovart-Balaguer J, Martinez-Garcia A. Research Progress on the role of Education in Tourism and Hospitality. A bibliometric analysis. J Hospitality Tourism Educ.1–13. https://doi.org/10.1080/10963758.2023.2180377

Martinez-Garcia A, Coll-Ramis MÀ, Horrach-Rossello P. Analysing leadership in tourism education research: a scientometric perspective. Eur J Geogr 04/02. 2024;15(1):67–80. https://doi.org/10.48088/ejg.m.ang.15.1.067.080 .

Martinez-Garcia A, Ferrer-Rosell B, Horrach-Rosselló P, Mulet-Forteza C. An overview of the European research in tourism, leisure and hospitali ty since the first indexed publication . IntechOpen.

Martínez-García A, Horrach-Rosselló P, Valluzi C, Mulet-Forteza C. impact of the European Accounting Review on accounting research (1992–2019). DC . 2021/12/30/ 18(2):98–142. https://doi.org/10.26784/issn.1886-1881.v18i2.438 .

Wilson M, Sampson M, Barrowman N, Doja A. Bibliometric Analysis of Neurology Articles Published in General Medicine journals. JAMA Netw Open Apr. 2021;1(4):e215840. https://doi.org/10.1001/jamanetworkopen.2021.5840 .

Brandt JS, Hadaya O, Schuster M, Rosen T, Sauer MV, Ananth CV. A Bibliometric Analysis of Top-Cited Journal Articles in Obstetrics and Gynecology. JAMA Netw Open Dec. 2019;2(12):e1918007. https://doi.org/10.1001/jamanetworkopen.2019.18007 .

Wang J, Chehrehasa F, Moody H, Beecher K. Does neuroscience research change behaviour? A scoping review and case study in obesity neuroscience. Neurosci Biobehav Rev Feb. 2024;22:105598. https://doi.org/10.1016/j.neubiorev.2024.105598 .

Xia Y, Yao RQ, Zhao PY, et al. Publication trends of research on COVID-19 and host immune response: a bibliometric analysis. Front Public Health. 2022;10:939053. https://doi.org/10.3389/fpubh.2022.939053 .

Article   PubMed   PubMed Central   Google Scholar  

Martinez-Garcia A, Horrach-Rosselló P, Mulet-Forteza C. Mapping the intellectual and conceptual structure of research on CoDa in the ‘Social sciences’ scientific domain. A bibliometric overview. J Geochem Explor. 2023/09/01/ 2023;252:107273. https://doi.org/10.1016/j.gexplo.2023.107273 .

Merigó JM, Mas-Tur A, Roig-Tierno N, Ribeiro-Soriano D. A bibliometric overview of the Journal of Business Research between 1973 and 2014. Journal of Business Research . 2015/12/01/ 2015;68(12):2645–2653. https://doi.org/10.1016/j.jbusres.2015.04.006 .

Yu L, Xu C, Zhang M, et al. Top 100 cited research on COVID-19 vaccines: a bibliometric analysis and evidence mapping. Hum Vaccin Immunother Dec. 2024;31(1):2370605. https://doi.org/10.1080/21645515.2024.2370605 .

Mulet-Forteza C, Genovart-Balaguer J, Horrach-Rosselló P. Bibliometric studies in the hospitality and tourism field: a Guide for Researchers. In: Okumus F, Rasoolimanesh SM, Jahani S, editors. Contemporary Research Methods in Hospitality and Tourism. Emerald Publishing Limited; 2022. pp. 55–76.

Ding Y, Rousseau R, Wolfram D. Measuring Scholarly Impact: Methods and Practice. 2014.

Svensson G. SSCI and its impact factors: a prisoner’s dilemma? Eur J Mark. 2010;44(1/2):23–33. 2/16/.

Hirsch JE. An index to quantify an individual’s scientific research output. Proc Natl Acad Sci USA. 2005;102(46):16569–72. /11/7/.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Egghe L. Theory and practise of the g-index. Scientometrics . 2006/10/01 2006;69(1):131–152. https://doi.org/10.1007/s11192-006-0144-7

Martinez-Garcia A, Horrach-Rosselló P, Mulet-Forteza C. Mapping the intellectual and conceptual structure of research on CoDa in the ‘Social sciences’ scientific domain. A bibliometric overview. J Geochem Explor. 2023;252:107273. /9//.

Miguel SE, Caprile L, Jorquera-Vidal I. Análisis de co-términos y de redes sociales para la generación de mapas temáticos. Profesional De La Informacion. 2008;17:637–47.

Martínez-López FJ, Merigó JM, Valenzuela-Fernández L, Nicolás C. Fifty years of the European Journal of Marketing: a bibliometric analysis. Eur J Mark. 2018;52(1/2):439–68. https://doi.org/10.1108/EJM-11-2017-0853 .

Chen C. Searching for intellectual turning points: progressive knowledge domai n visualization. Proc Natl Acad Sci USA. 2004;101(suppl1):5303–10. /4/6/.

van Eck NJ, Waltman L. Software survey: VOSviewer, a computer program for bibliometric mapping. Scientometrics. 2010;84(2):523–38. https://doi.org/10.1007/s11192-009-0146-3 . /08/01 2010.

Article   PubMed   Google Scholar  

Synnestvedt MB, Chen C, Holmes JH. CiteSpace II: visualization and knowledge discovery in bibliographic databases. AMIA Annu Symp Proc . 2005;2005:724-8.

Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol Nov. 2018;19(1):143. https://doi.org/10.1186/s12874-018-0611-x .

Villeneuve PJ, Chen L, Stieb D, Rowe BH. Associations between outdoor air pollution and emergency department visits for stroke in Edmonton, Canada. Eur J Epidemiol. 2006;21(9):689–700. https://doi.org/10.1007/s10654-006-9050-9 .

Sun Y, Milando CW, Spangler KR, et al. Short term exposure to low level ambient fine particulate matter and natural cause, cardiovascular, and respiratory morbidity among US adults with health insurance: case time series study. Bmj Feb. 2024;21:384:e076322. https://doi.org/10.1136/bmj-2023-076322 .

Burnett RT, Pope CA 3rd, Ezzati M, et al. An integrated risk function for estimating the global burden of disease attributable to ambient fine particulate matter exposure. Environ Health Perspect Apr. 2014;122(4):397–403. https://doi.org/10.1289/ehp.1307049 .

Shah AS, Lee KK, McAllister DA, et al. Short term exposure to air pollution and stroke: systematic review and meta-analysis. Bmj Mar. 2015;24:350:h1295. https://doi.org/10.1136/bmj.h1295 .

Lipsett MJ, Ostro BD, Reynolds P, et al. Long-term exposure to air pollution and cardiorespiratory disease in the California teachers study cohort. Am J Respir Crit Care Med Oct. 2011;1(7):828–35. https://doi.org/10.1164/rccm.201012-2082OC .

Song C, He J, Wu L, et al. Health burden attributable to ambient PM(2.5) in China. Environ Pollut Apr. 2017;223:575–86. https://doi.org/10.1016/j.envpol.2017.01.060 .

Yin P, Brauer M, Cohen AJ, et al. The effect of air pollution on deaths, disease burden, and life expectancy across China and its provinces, 1990–2017: an analysis for the global burden of Disease Study 2017. Lancet Planet Health Sep. 2020;4(9):e386–98. https://doi.org/10.1016/s2542-5196(20)30161-3 .

Lotka AJ. The frequency distribution of Scientific Productivity. J Wash Acad Sci Wash D C. 1926;19(12):317–23.

Google Scholar  

McCain KW. Mapping Economics through the Journal literature: an experiment in Journal Cocitation Analysis. J Association Inform Sci Technol. 1991;42:290–6.

Sun S, Nan D, Che S, Kim J-H. Investigating the knowledge structure of research on massively multiplayer online role-playing games: a bibliometric analysis. Data Inf Manag. 2022;8:100024.

Brook RD, Rajagopalan S, Pope CA 3, et al. Particulate matter air pollution and cardiovascular disease: an update to the scientific statement from the American Heart Association. Circulation Jun. 2010;1(21):2331–78. https://doi.org/10.1161/CIR.0b013e3181dbece1 .

Wellenius GA, Burger MR, Coull BA, et al. Ambient air pollution and the risk of acute ischemic stroke. Arch Intern Med Feb. 2012;13(3):229–34. https://doi.org/10.1001/archinternmed.2011.732 .

Wellenius GA, Schwartz J, Mittleman MA. Air pollution and hospital admissions for ischemic and hemorrhagic stroke among medicare beneficiaries. Stroke Dec. 2005;36(12):2549–53. https://doi.org/10.1161/01.Str.0000189687.78760.47 .

Chiu HF, Yang CY. Short-term effects of fine particulate air pollution on ischemic stroke occurrence: a case-crossover study. J Toxicol Environ Health A. 2013;76(21):1188–97. https://doi.org/10.1080/15287394.2013.842463 .

Article   CAS   PubMed   Google Scholar  

Yu XB, Su JW, Li XY, Chen G. Short-term effects of particulate matter on stroke attack: meta-regression and meta-analyses. PLoS ONE. 2014;9(5):e95682. https://doi.org/10.1371/journal.pone.0095682 .

Chowdhury S, Dey S. Cause-specific premature death from ambient PM2.5 exposure in India: Estimate adjusted for baseline mortality. Environ Int May. 2016;91:283–90. https://doi.org/10.1016/j.envint.2016.03.004 .

Sampedro J, Markandya A, Rodés-Bachs C, Van de Ven DJ. Short-term health co-benefits of existing climate policies: the need for more ambitious and integrated policy action. Lancet Planet Health Jul. 2023;7(7):e540–1. https://doi.org/10.1016/s2542-5196(23)00126-2 .

Burnett R, Chen H, Szyszkowicz M, et al. Global estimates of mortality associated with long-term exposure to outdoor fine particulate matter. Proc Natl Acad Sci U S Sep. 2018;18(38):9592–7. https://doi.org/10.1073/pnas.1803222115 .

Global regional et al. and national comparative risk assessment of 79 behaviournvironmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet . Oct 8 2016;388(10053):1659–1724. https://doi.org/10.1016/s0140-6736(16)31679-8

Chen G, Wang A, Li S, et al. Long-term exposure to Air Pollution and Survival after ischemic stroke. Stroke Mar. 2019;50(3):563–70. https://doi.org/10.1161/strokeaha.118.023264 .

Liang R, Chen R, Yin P, et al. Associations of long-term exposure to fine particulate matter and its constituents with cardiovascular mortality: a prospective cohort study in China. Environ Int Apr. 2022;162:107156. https://doi.org/10.1016/j.envint.2022.107156 .

Zhang Y, Li W, Jiang N, et al. Associations between short-term exposure of PM(2.5) constituents and hospital admissions of cardiovascular diseases among 18 major Chinese cities. Ecotoxicol Environ Saf Nov. 2022;246:114149. https://doi.org/10.1016/j.ecoenv.2022.114149 .

Cai M, Lin X, Wang X, et al. Long-term exposure to ambient fine particulate matter chemical composition and in-hospital case fatality among patients with stroke in China. Lancet Reg Health West Pac Mar. 2023;32:100679. https://doi.org/10.1016/j.lanwpc.2022.100679 .

Lu H, Wang R, Li J, et al. Long-term exposure to the components of fine particulate matters and disability after stroke: findings from the China National Stroke screening surveys. J Hazard Mater Oct. 2023;15:460:132244. https://doi.org/10.1016/j.jhazmat.2023.132244 .

Tian Y, Liu H, Wu Y, et al. Association between ambient fine particulate pollution and hospital admissions for cause specific cardiovascular disease: time series study in 184 major Chinese cities. BMJ (Clinical Res ed) Dec. 2019;30:367:l6572. https://doi.org/10.1136/bmj.l6572 .

Cai M, Lin X, Wang X, et al. Ambient particulate matter pollution of different sizes associated with recurrent stroke hospitalization in China: a cohort study of 1.07 million stroke patients. Sci Total Environ Jan. 2023;15(Pt 2):159104. https://doi.org/10.1016/j.scitotenv.2022.159104 .

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Acknowledgements

We thank all study participants and data collectors for their participation and. cooperation. We also thank the Cerebrovascular Disease Center of Gansu Provincial. Hospital for their comprehensive cooperation and data support. We would like to. Thank the Key Laboratory of Cerebrovascular Disease of Gansu Province, China. (20JR10RA431), the Scientific Research Foundation of Gansu Provincial Hospital, China (Key Discipline Project) (2019 − 395), and Inhalable fine particulate matter. Promotes the activation of DAPKI/ERK pathway in brain tissue and its effect on. Ischemic stroke /ZX-62000001-2023-457.

This study was funded by the Key Laboratory of Cerebrovascular Disease of Gansu Province, China (20JR10RA431),the Scientific Research Foundation of Gansu Provincial Hospital, China (Key Discipline Project) (2019 − 395) and Inhalable fine particulate matter promotes the activation of DAPKI/ERK pathway in brain tissue and its effect on ischemic stroke /ZX-62000001-2023-457. There were no roles in study design, data collection, analysis, decision to publish, or manuscript preparation.

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Liu, Q., Yang, S. & Chen, H. Global trends and hotspots in the study of the effects of PM2.5 on ischemic stroke. J Health Popul Nutr 43 , 133 (2024). https://doi.org/10.1186/s41043-024-00622-3

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The Role of 3D Printing in Medical Applications: A State of the Art

1 Aid4Med S.r.l., Udine 33100, Italy

Augusto Palermo

2 Head 3 Orthopaedic Department, Istituto Auxologico Italiano IRCCS Capitanio Hospital, Milan 20122, Italy

Bernardo Innocenti

3 BEAMS Department, Université Libre de Bruxelles, Bruxelles 1050, Belgium

Three-dimensional (3D) printing refers to a number of manufacturing technologies that generate a physical model from digital information. Medical 3D printing was once an ambitious pipe dream. However, time and investment made it real. Nowadays, the 3D printing technology represents a big opportunity to help pharmaceutical and medical companies to create more specific drugs, enabling a rapid production of medical implants, and changing the way that doctors and surgeons plan procedures. Patient-specific 3D-printed anatomical models are becoming increasingly useful tools in today's practice of precision medicine and for personalized treatments. In the future, 3D-printed implantable organs will probably be available, reducing the waiting lists and increasing the number of lives saved. Additive manufacturing for healthcare is still very much a work in progress, but it is already applied in many different ways in medical field that, already reeling under immense pressure with regards to optimal performance and reduced costs, will stand to gain unprecedented benefits from this good-as-gold technology. The goal of this analysis is to demonstrate by a deep research of the 3D-printing applications in medical field the usefulness and drawbacks and how powerful technology it is.

1. Introduction

Among the different manufacturing processes that are currently adopted by the industry, the 3D printing is an additive technique. It is a process through which a three-dimensional solid object, virtually of any shape, is generated starting from a digital model. Medical 3D printing was once an ambitious pipe dream. However, time and investment made it real. Nowadays, the 3D printing technology represents a big opportunity to help pharmaceutical and medical companies to create more specific drugs, enabling a rapid production of medical implants and changing the way that doctors and surgeons plan procedures [ 1 ]. This technology has multiple applications, and the fastest growing innovation in the medical field has been represented by the advent of the 3D printing itself [ 2 ]. Five technical steps are required to finalize a printed model. They include selecting the anatomical target area, the development of the 3D geometry through the processing of the medical images coming from a CT/MRI scan, the optimization of the file for the physical printing, and the appropriate selection of the 3D printer and materials ( Figure 1 ). This file represents the guidance for the subsequent printing, “slicing” that digital design model into cross sections. That “sliced” design is then sent to a 3D printer, which manufactures the object by starting at the base layer and building a series of layers on top until the object is built using the raw materials that are needed for its composition. A patient-specific model with anatomical fidelity created from imaging dataset is finally obtained.

3D-printing workflow.

In this way, the 3D printing has the potential to significantly improve the research knowledge and the skills of the new generation of surgeons, the relationship between patient and surgeon [ 3 ], increasing the level of understanding of the disease involved, and the patient-specific design of implantable devices and surgical tools [ 4 – 6 ] and optimize the surgical process and cost [ 7 ]. Nowadays, different printing techniques and material are available in order to better reproduce the patient anatomy. Most of the available printing materials are rigid and therefore not optimum for flexibility and elasticity, unlike biological tissue [ 8 ]. Therefore, there are nowadays materials able to close the gap between the real anatomy and the reproduced one, especially considering the soft tissue [ 9 , 10 ]. In this analysis, an overview of the 3D printing application in medical field is presented, highlighting the usefulness and limitations and how it could be useful for surgeons.

2. Additive Manufacturing Technologies

The 3D-printing techniques have grown in the last decades starting from 1986 when the first stereolithographic (SLA) systems were introduced in practice. Seven are the technical processes related to the 3D printing, each of which is represented by one or more commercial technologies, as shown by the ASTM International [ 11 ]. All the processes are listed in Table 1 that reported information about the technologies involved, the materials used, and the medical applications related to each process [ 12 ]. A comparison among all the seven techniques is proposed in the same table showing the advantages and disadvantages related to all the processes. Each process uses specific materials with specific properties that relate to medical applications, which are also summarized in Table 1 . This general information helps the users to better choose the right technology depending on the application needed.

Summary of the 3D-printing process and technologies, focus on materials needed and medical applications, and comparison among the 3D-printing technologies.

These technologies and the related advantages enable the researchers to improve existing medical applications that use 3D-printing technology and to explore new ones. The medical goal that has been already reached is significant and exciting, but some of the more revolutionary applications, such as bio/organ printing, require more time to evolve [ 2 ].

3. Transformation Process and Materials Used

Materials used in 3D printing are transformed during the production of the specific model by changing their consistency. This process is named cure and can be done in different ways: a melting of a hard filament in order to give the desired form to the model by the material distortion, liquid solidification for the construction of the structure and powder solidification. All these processes require filler or support material in lattice forms avoiding distortion of the model while the material is being cured. The support material can be easily removed by hand with a cutting tool; however, there is the risk to leave impression on the surface requiring an additional polishing in order to obtain a good-quality printing. The risk of damaging the model, losing details, or break the geometry is really high [ 23 ].

The correct selection of the material is directly linked to the selection of the 3D-printing process and printer, as well as the requirements of the model. Related to medical application, similarly to other applications, different anatomical structures need different mechanical properties of the materials to fulfill the required performance of the printed object [ 8 ]. The main distinction among the different materials that characterize the human body is between rigid and soft materials. Human bones are an example of rigid tissue and ligaments or articular cartilage are examples of soft materials. Bones are the simplest and easiest biological tissue to be produced by 3D printing as the majority of the materials are rigid. The materials used in 3D printing to model the bone structure are for example acrylonitrile butadiene styrene (ABS) [ 23 ], powder of plasters [ 24 ], and hydroquinone [ 8 ].

Relating to soft tissues, deeper research is still needed in order to decrease the gap between a 3D-printed anatomical model and the human structure. Most of the 3D-printing materials present a lack of realism to mimic adequately a soft human biological tissue. Thus, postprocessing may be necessary in order to soften the printed structures. Some examples are given in the reproduction of cartilaginous tissues [ 25 ], arteries for practicing valve replacement [ 26 ], hepatic segment [ 27 ], and hearts [ 28 ]. An interesting example is the development of a 3D-printed brain aneurysm using the flexible TangoPlus™ photopolymer [ 29 ] that represented a useful tool to plan the operative strategy in order to treat congenital heart disease. Furthermore, some of the materials used are urethane and rubber-like material, mixed with a rigid photopolymer, to reasonably mimic the artery structure due to their Shore value and elastic properties similar to the physiological one [ 30 , 31 ].

For a promising future, the multimaterial composites seem to represent a good chance for the 3D printing of human tissues since none of the current available material is able to fully mimic elastic and biological tissues. Multimaterial composites may be designed based on the capacity of the selected biological material to replicate the mechanical properties of human tissue [ 32 ]. Mechanical testing may represent a necessary tool to analyze the biomechanical response and validate the artificial material.

Moreover, it is also important to mention that 3D printing allows the reproduction of implantable custom device, but still deeper research needs to be done in order to examine the differences between the traditional and additive manufacturing in terms of mechanical and structural properties, especially fatigue limit needs to be examined further [ 33 ].

4. Role of 3D Printing in Medical Field

Every year, 3D printing offers more and more applications in the healthcare field helping to save and improve lives in ways never imagined up to now. In fact, the 3D printing has been used in a wide range of healthcare settings including, but not limited to cardiothoracic surgery [ 34 ], cardiology [ 26 ], gastroenterology [ 35 ], neurosurgery [ 36 ], oral and maxillofacial surgery [ 37 ], ophthalmology [ 38 ], otolaryngology [ 39 ], orthopaedic surgery [ 22 ], plastic surgery [ 40 ], podiatry [ 41 ], pulmonology [ 42 ], radiation oncology [ 43 ], transplant surgery [ 44 ], urology [ 45 ], and vascular surgery [ 46 ].

Thanks to the different benefits that this technology could induce in the field, the main direct applications of 3D printing in the medical and clinical field are as follows [ 47 ]:

• Used for personalized presurgical/treatment and for preoperative planning. This will lead to a multistep procedure that, integrating clinical and imaging information, will determine the best therapeutic option. Several studies have demonstrated that patient-specific presurgical planning may potentially reduce time spent in the operating room (OR) and result in fewer complications [ 48 , 49 ]. Moreover, this may lead to reduced postoperative stays, decreased reintervention rates, and lower healthcare costs. The 3D-printing technology allows to provide to the surgeon a physical 3D model of the desired patient anatomy that could be used to accurately plan the surgical approach along with cross-sectional imaging or, alternatively, modelling custom prosthetics (or surgical tool) based on patient-specific anatomy [ 50 – 54 ]. In this way, a better understanding of a complex anatomy unique to each case is allowed [ 52 – 56 ]. Furthermore, the 3D printing gives the possibility to choose before the implantation the size of the prostheses components with very high accuracy [ 57 – 59 ].
• Customize surgical tools and prostheses: the 3D printing can be used to manufacture custom implants or surgical guides and instruments. Therefore, the customization of surgical tools and prostheses means a reduction of cost given by the additive manufacturing technique [ 52 – 54 , 60 ].
• Study of osteoporotic conditions: following a pharmacological treatment, 3D printing is useful in validating the results achieved by the patient. This enables a more accurate estimation of patientʼs bone condition and a better decision on the surgical treatment [ 15 ].
• Testing different device in specific pathways: a clear example is the reproduction of different vascular patterns to test the effectiveness of a cardiovascular system used to treat peripheral and coronary artery disease [ 61 ]. In this way, the 3D printing enables us to quickly produce prototypes of new design concepts or improvements to existing devices.
• Improving medical education: 3D-printed patient-specific models have demonstrated that they can increase performance and foster rapid learning [ 62 ], while significantly ameliorating the knowledge, management, and confidence of the trainees regardless of the area of expertise [ 8 ]. The benefits of 3D printing in education are the reproducibility and safety of the 3D-printed model with respect to the cadaver dissection, the possibility to model different physiologic and pathologic anatomy from a huge dataset of images, and the possibility to share 3D models among different institutions, especially with ones that have fewer resources [ 63 ]. 3D printers that have the capability to print with different densities and colours can be used to accentuate the anatomical details [ 64 , 65 ].
• Patient education: patient-centered cares makes patient education one of the top priorities for most healthcare providers. However, communicating imaging reports verbally or by showing patients their CT or MRI scans may not be effective; the patients may not fully understand 2D images representation of a 3D anatomy. On the contrary, 3D printing may improve the doctor-patient communication by showing the anatomic model directly [ 66 , 67 ].
• Storage of rare cases for educational purposes: this role is closely linked to the previous one. This allows the generation of a large dataset composed by datasets of patients affected by rare pathologies, allowing the training of surgeons in specific applications [ 52 – 54 ].
• Improve the forensic practice: in the courtroom, a 3D model could be used to easily demonstrate various anatomic abnormalities that may be difficult to jury members to understand using cross-sectional imaging [ 68 ].
• Bioprinting: the 3D printing allows also the modelling of implantable tissue. Some examples are the 3D printing of synthetic skin for transplanting to patients, who suffered burn injuries [ 69 ]. It may also be used for testing of cosmetic, chemical, and pharmaceutical products. Another example is the replicating of heart valves using a combination of cells and biomaterials to control the valve's stiffness [ 26 ] or the replicating of human ears using molds filled with a gel containing bovine cartilage cells suspended in collagen [ 70 ].
• Personalized drug 3D printing: the 3D printing of drugs consists of the printing out the powdered drug layer to make it dissolve faster than average pills [ 71 ]. It allows also personalization of the patient's needed quantity [ 2 ].
• Customizing synthetic organs: the 3D printing may represent an opportunity to save life reducing the waiting list of patients that need transplantation [ 72 ]. Bioprinted organs may also be used in the future by pharmaceutical industries to replace animal models for analyzing the toxicity of new drugs [ 73 ].

Therefore, these examples clearly demonstrated that 3D printing is one of the most disruptive technologies that have the potential to change significantly the clinical field, improving medicine and healthcare, making care affordable, accessible, and personalized. As printers evolve, printing biomaterials get safety regulated and the general public acquires a common sense about how 3D printing works.

4.1. Lack of Regulation

The biomedical field is one of the areas in which 3D printing has already shown its potentialities and that, in not too distant future, may be one of the key elements for the resolution of important problems related to human health that still exist.

Nowadays, despite the additive manufacturing offers a great potential for the manufacturing, the 3D-printing products do not have a proper legal status that defines them, both for implantable and nonimplantable devices. All the 3D-printed products are categorized as custom-made device under the Regulation (EU) 2017/745 of the European Parliament and of the Council of the 5 April 2017 [ 74 ]. They are defined as follow: “ any device specifically made in accordance with a written prescription of any person authorized by national law by virtue of that person's professional qualifications which gives, under that person's responsibility, specific design characteristics, and is intended for the sole use of a particular patient exclusively to meet their individual conditions and needs ”. Differently for mass-produced devices “ which need to be adapted to meet the specific requirements of any professional user and devices which are mass-produced by means of industrial manufacturing processes in accordance with the written prescriptions of any authorized person shall not be considered to be custom-made devices ” [ 75 ]. Indeed, manufacturers of custom-made devices shall only be guaranteed by an obligation of conformity assessment procedures upon which the device shall be compliant with safety and performance requirements [ 76 ]. Furthermore, the regulation states that “ Devices, other than custom-made or investigational devices, considered to be in conformity with the requirements of this Regulation shall bear the CE marking of conformity ” [ 77 ]. Thus, these medical devices do not require affixation of CE markings: a significant and constraining procedure demonstrating the safety and the performance of the device for the patient. Moreover, the custom-made devices do not require the UDI System (Unique Device Identification system) as reported in the Article 27, Comma 1 of the regulation.

A different approach has to be applied for custom-made implants, such as dental prostheses, that are defined as “ any device, including those that are partially or wholly absorbed, which is intended :

• to be totally introduced into the human body, or
• to replace an epithelial surface or the surface of the eye,

by clinical intervention and which is intended to remain in place after the procedure.

Any device intended to be partially introduced into the human body by clinical intervention and intended to remain in place after the procedure for at least 30 days shall also be deemed to be an implantable .” [ 78 ]. The custom-made implantable devices require the CE marking in order to guarantee the safety and to be commercialized.

The EU has been working for many years on an update to the Medical Devices Directive. This proposed legislation has many noble attributes in addition to overcoming the gaps of the existing Medical Devices Directive, such as supporting technology and science innovation, while simultaneously strengthening patient safety. However, the current version of the draft Regulation lacks some depth that is mandatory to safeguard safe usage of 3D-printing technology and, thus, enable its increasing prevalence in medicine.

4.2. Examples of Application of 3D Printing in Paediatric Cases

Three-dimensional (3D) modelling and printing greatly supports advances in individualized medicine and surgery. Looking to the field of paediatrics, it is possible to identify four main applications categories: surgical planning, prostheses, tissue construct, and drug printing.

There are many successful cases that demonstrate the potential of the additive manufacturing in surgical planning in paediatric cases. In particular, most of the applications of 3D printing reported in the literature are related to the congenital heart disease [ 29 ]. This is due to the fact that children have a smaller chest cavity than adults, and the surgical treatment in paediatric cases may be much more difficult. The additive manufacturing helps the surgeons to have more information than the only ones that imaging technologies can afford. It helps the surgeon in the spatial orientation inside the cavities of a small infant heart and in simulating the surgical approach and steps of the operation with high fidelity [ 79 ]. This leads to shorter intraoperative time that per se has significant impact on complication rate, blood loss, postoperative length-of-stay, and reduced costs [ 80 ]. An example of the application of the 3D printing in the paediatric congenital heart disease treatment is a study reported in the literature based on the development of a 3D heart model of a 15-years-old boy to improve interventional simulation and planning in patient with aortic arch hypoplasia. The 3D-printed model allowed simulation of the stenting intervention. The assessment of optimal stent position, size, and length was found to be useful for the actual intervention in the patient. This represents one of the most technically challenging surgical procedures which opens the door for potential simulation applications of a 3D model in the field of catheterization and cardiovascular interventions [ 81 ].

Another study proposed in which the 3D printing had a relevant role consists in a clinical preoperative evaluation on five patients ranged from 7 months to 11 years of age affected by a double outlet right ventricle with two well-developed ventricles and with a remote ventricular septal defect. The three-dimensional printed model based on the data derived from computed tomography (CT) or magnetic resonance (MRI) contributed to a more complete appreciation of the intracardic anatomy, leading to a successful surgical repair for three of the five patients. [ 82 ] Lastly, CT and MRI data were used to construct 3D digital and anatomical models to plan a heart transplantation surgical procedure of two patients of 2 and 14 years old affected relatively by hypoplastic left heart syndrome and pulmonary atresia with a hypoplastic right ventricle. These physical models allowed the surgeon and the paediatric cardiologist to develop the optimal surgical treatment during the heart transplantation anticipating problems that may arise during the procedure. The specific dimensions and distances can be measured, and heart transplantation can be planned [ 83 ].

The importance of three-dimensional printing has been demonstrating also in other application. The additive manufacturing in fact has been used to plan surgical treatment of paediatric orthopaedic disorders [ 84 ]. The 3D model of a 2-year-old male child was produced in order to plan the surgical treatment for his multisutural craniosynostosis with a history of worsening cranial deformity. Other than the turribrachycephalic skull, the child also had greatly raised intracranial pressure with papilledema and copper beaten appearance of the skull. Thorough preoperative planning enabled faster surgery and decreased anesthesia time in a compromised patient [ 85 ].

Another study, based on 13 cases of multiplane spinal or pelvic deformity, was developed in order to demonstrate that the three-dimensional printing may represent a useful tool in the surgical planning of complex paediatric spinal deformities treatment [ 86 ].

Changing the final goal of the additive manufacturing, other applications cases are reported in the literature to demonstrate the usefulness in the production of paediatric patient-specific prostheses. An example in the literature is given by the development of a low-cost three-dimensional printed prosthetic hand for children with upper-limb reductions using a fitting methodology that can be performed at a distance [ 87 ]. This specific case demonstrates that the advancements in computer-aided design (CAD) programs, additive manufacturing, and imaging editing software offer the possibility of designing, printing, and fitting prosthetic hands devices overcoming the costs limitation. As a consequence, the advantages of 3D-printed implants over conventional ones are in terms of customizability and cost as seems to be clear from the previous example. On the contrary, the major adversity is related to the rapid physical growth that makes the customize prostheses outsized frequently. This leads to the production of advanced technological implant that, due to their high complexity and weight, increases cost. The additive manufacturing can be used to fabricate rugged, light-weight, easily replaceable, and very low-cost prostheses for children [ 88 ]. The major prostheses lack is related to the ability to communicate with the brain in terms of sensibility. With the advent of bioprinting, cellular prostheses could be an interesting area of research, which can lead to integrated prostheses in the brain communication system, and exhibit more biomimicry with tissue and organ functionalities [ 89 ].

Related to bioprinting, there are few applications nowadays involved in the tissues production in regenerative medicine. Many different tissues have been successfully bioprinted as reported in many journal articles [ 90 ] including bone, cartilage, skin, and even heart valves. However, the bioprinted tissues and organs are at the laboratory level; a long way needs to be travelled to achieve successful clinical application [ 91 ].

Last but not the least, the additive manufacturing in terms of drug printing may also represent an innovative technique in the production of patient-specific medicine with regard to the composition and the dose needed by the patients. The drug-printing introduces the concept of tailor-made drugs in order to make drugs safer and more effective. Especially for children, furthermore, drug-printing represents the possibility of choosing colour, shape, and design of the medication, reducing the resistance in taking them. Imagine a paediatrician talking to a four-year-old child who is having trouble adjusting to taking daily doses of steroids after being diagnosed with Duchenne muscular dystrophy the previous month. 3D printing allows us to design in particular shape the drug, making medicine more appealing to the child [ 92 ]. It is amental to note that changing the shape of a capsule does not have to lead to different dose and drug properties, such as drug release or dissolution rate [ 93 ].

5. Conclusions

The 3D printing in medical field and design needs to think outside the norm for changing the health care. The three main pillars of this new technology are the ability to treat more people where it previously was not feasible, to obtain outcomes for patients and less time required under the direct case of medical specialists. In few words, 3D printing consists in “enabling doctors to treat more patients, without sacrificing results” [ 94 ].

Therefore, like any new technology, 3D printing has introduced many advantages and possibilities in the medical field. Each specific case in which 3D printing has found application shown in this analysis is a demonstration of this. However, it must be accompanied by an updated and current legislation in order to guarantee its correct use.

Acknowledgments

The publication of the article was funded through the collaboration between Aid4Med S.r.l. and the Universitè Libre de Bruxelles.

Conflicts of Interest

The authors declare that there are no conflicts of interest regarding the publication of this paper.