“Good patients manage their health”:: a critical conceptual analysis of the patient as health manager

This conceptual study builds further upon an interview study with general practitioners and cardiologists (N = 12) on their experience with and views on (digital) self-tracking in the clinical practice (Gabriels & Moerenhout, 2018). One of the key themes arising in our body of data is the concept of the patient as health manager. Both in medical literature and on a broader societal level, the patient as manager of his or her health and – if applicable – chronic illness is perceived to be a desirable and even necessary evolution to increase efficiency and to reduce costs (Topol, 2015 and De Block, 2016). The current surge in self-tracking technology is a strong facilitator of this type of patient empowerment through self-care.Drawing upon our previous empirical work, we present a critical conceptual analysis of the patient-manager. First, we explore the concepts behind this notion. In so doing, we focus on the specific interpretation of autonomy leading to an isolated and detached patient position and on the outcome of an increased patient responsibility. Second, we look at the role of self-tracking technology: data collection is no longer confined to the medical environment, but conducted in the private sphere of the patient. Digital self-tracking often lacks contextual awareness, preferably operating in a one-size-fits-all model. Overall, this analysis leads to the identification of several problems and pitfalls in the patient-manager. Alternatively, we suggest a different approach stemming from care ethics and relational autonomy (specifically focusing on Mol, 2008) that could lead to a better integration of self-tracking in the patient-doctor relationship and in a broader medical context