Pakistan Journal of Medical & Health Sciences

The Digital Doctor–Patient Divide: Is Technology Weakening Human Connection?

NAVEED SHUJA — 2026-07-30

The healthcare industry is moving towards becoming a digital environment¹. Incorporation of electronic medical records, telemedicine, artificial intelligence, wearable technology, mobile health applications, and automated clinical decision-making systems have become integral to daily clinical practice. The technologies have made it easier to access care, quicker in diagnosing, streamlined in administration and allowed physicians to deal with massive amounts of medical data. However, as in every other area, there is an uncomfortable question that has arisen: does technology make healthcare more powerful, but make the human element at its very core less so²?

Traditionally, the doctor-patient relationship relies on attention, trust, empathy and meaningful communication³. Patients don't go to the doctor just for a prescription, investigation or procedure. They also want to be reassured, understood and validated for their fears and their individual situations. Clinically, a diagnosis might be given in clinical terms, but to the patient, it can be uncertainty, disruption, financial burden, or fear of death. Medicine is able to respond to these dimensions of illness because of human interaction. Once technology takes over the interaction, however, the patient might feel diminished, to just a set of symptoms, numbers, or a screen⁴.

A very obvious example of this is the computer standing between the doctor and the patient⁵. To enhance documentation, safety, continuity, and coordination of care, EMRs were introduced. However, in reality, doctors often spend a significant portion of their consultations filling in code boxes, typing and checking alerts, and hitting mandatory fields. Eye contact is broken, communication is broken up, and the patient feels like his/her concerns are not being heard. Both physically and emotionally the doctor may be absent; however, he may be there physically, but not there emotionally or visually⁶.

This is no sign of apathy among the professionals⁷. Many clinicians are operating under intense pressures, have little consultation time, and have a high amount of documentation needs. Digital systems may require ongoing data input, frequent authentication, and adherence to intricate administrative procedures. This means doctors may be unable to focus on listening to patients and also on technology. This ultimately means a form of distracted medicine, neither the patient nor the digital task can be fully attended to⁸.

Telemedicine has added another dimension to the digital divide⁹. It has provided medical guidance in remote areas, patients with poor mobility, people who do not have access to specialized facilities, and to those who need regular follow-ups. In times of public health emergencies, remote consultation has also safeguarded patients and health care workers. Even so, while virtual care can provide many of the benefits of in-person care, it cannot replace the emotional and diagnostic depth of an in-person interaction¹⁰.

Clinical understanding is in the centre of non-verbal communication¹¹. Body language, tone of voice, worry in the eyes of a family member, poor hygiene, laboured movement or tears can give away what hasn't been said. These symptoms can go unnoticed on the telephone or be inadequately conveyed on video. Physical exam is also limited. While remote technologies can serve as an aid to monitoring and visual assessment, there is a lack of consistency in being able to substitute for touch and close observation or the reassurance that a clinician provides simply by being present¹².

The advent of AI adds additional options and anxieties¹³. AI-powered systems can detect patterns, predict risks, analyze pictures, summarize documentation, and aid in diagnosis. Taken appropriately they can minimize errors and free the clinician's time for patient care. But when too much reliance is placed on automated suggestions, however, a new distance may be created. Clinical decisions can seem like algorithm-driven rather than conversational. The patient may find it difficult to accept the final decision, especially when the computer-generated advice is not in line with the patient's preferences or the clinician's evaluation¹⁴.

The probabilities cannot be all the medicine¹⁵. Two people with the same diagnosis could come to different decisions depending on their values, family commitments, financial situation, religious beliefs, risk tolerance or previous health experiences. While technology can make a prediction, technology cannot make the determination for itself of what is the most important outcome for a particular patient. That's a matter of conversation, moral reasoning and valuing human concerns¹⁶.

The digital divide is also problematic for patients too¹⁷. Patient portals, mobile apps and virtual consultation platforms can be challenging for older adults, people with lower literacy levels, those with a disability, economically disadvantaged communities or individuals who don't always have the internet at their fingertips. As access to health care increasingly goes online, technology can inadvertently leave out those who are already less likely to access care. An efficient system can thus create an inequity if other methods of access are not available¹⁸.

Another consideration is privacy¹⁹. Patients might be less inclined to share sensitive information if they are not confident how their digital information is being stored, shared, and analysed. Trust can be weakened by the potential of data breaches, unauthorized access or commercial use of health information. While confidentiality is always a fundamental component of medical care, it is an area that needs to be reemphasized when dealing with digital medicine, as informed consent, cybersecurity, transparency, and data ownership are all areas that need to be refocused²⁰.

Even with all these worries, however, technology is not the saboteur of human relations³. The actual issue is the design, operational and user of it. By minimizing repetitive tasks, enhancing access to information, minimizing medication errors and assisting follow-up, a well-designed digital system can help to strengthen the doctor–patient relationship. Telemedicine can provide continuity of care for patients who would otherwise have no care. AI can streamline complex information and eliminate some of the administrative tasks for clinicians. Wearable devices can enable patients to be actively involved in the management of chronic disease¹⁴.

The goal should therefore not be to reject technology, but to humanize it⁶. Digital tools should be a means to support clinical communication, not be the focus of it. These are simple, but effective, ways to maintain connection with the patient while using the computer: greet the patient before hitting the keyboard, make eye contact with the patient, tell the patient why you are using the computer, stop sending information when it is sensitive, and summarize what you hear the patient say before ending the consultation. Documentation systems should be rethought where possible to minimize unnecessary clicks, duplication of information and intrusion of alerts¹⁸.

There is a need for a corresponding change in medical education⁸. The future health care professional needs more than digital competence; s/he needs to be taught to be empathetic, to listen to others, to make shared decisions, and to communicate on virtual platforms. Even if the consultation is technically correct, it could still be unsuccessful if the patient feels unheard, confused, or emotionally misunderstood. Diagnostic accuracy and efficiency, then, should not be the only metric to define professional excellence in the digital age; the patient's experience of being heard and respected ought to be a part of that assessment as well¹⁶.

Healthcare institutions have an equal responsibility⁵. If your bookings are too full and you have too much paperwork, you can't expect to have meaningful relationships. Policies should safeguard a suitable period for consultation, take into account the involvement of clinicians and patients in the development of digital systems, and evaluate the impact of new technologies on communication. Technology should be considered not just on the basis of speed and cost, but also how it impacts trust, dignity, access and continuity of care¹¹.

It is not a digital doctor–patient divide that has to happen⁹. It's a warning that medical advancements are not just about technology. A healthcare organization could have a very connected IT landscape based on devices and databases but much less connected at the human level. Innovation shouldn't be a matter of choice, the future of medicine shouldn't be like that. The best health care of the future will be a combination of technology and people¹⁹.

Finally, patients should not feel like the competition for their doctor's attention is between the screen, the algorithm and their electronic record². This is not about technology overwhelming the doctor/patient relationship; it's about technology helping to make the patient more visible to the clinician. The challenge for contemporary medicine is not just to be more digital but to make sure that all advances in digital technology strengthen the compassion, trust and humanity that makes healthcare healing¹³.

A Prospective Study of the Forensic Implications of Carpal Tunnel Syndrome in Relation to Radiological and Orthopaedic Evaluation

Arsalan Hussain — 2026-07-30

Background: The most prevalent entrapment neuropathy of the upper limb is Carpal tunnel syndrome (CTS) which is a prominent source of hand pain, numbness disorder, impaired functions and occupational disability. Clinical examination and objective investigations should be combined to obtain an accurate diagnosis especially in the patients who are being evaluated due to a disability and in medico-legal assessment. Radiological imaging and electrodiagnostic tests are becoming crucial in the diagnosis confirmation, identification of disease severity and scope of functional deficit. To determine the forensic relevance of carpal tunnel syndrome by comparing the orthopaedic examination data with the radiological and electrodiagnostic data among individuals who present with clinically suspected CTS.

Methods: This observational prospective study was done in the Orthopaedic surgery, Radiology, physical medicine and rehabilitation and forensic medicine departments of the Lahore general hospital, Lahore, over the course of 12 months. A consecutive non-probability sampling was used to enroll 120 consecutive patients, with a clinical suspicion of CTS. The patients were all subjected to extensive clinical examination conducted as Phalen test, Tinel sign, Durkan compression test, motor and sensory examination, and nerve conduction test. All patients were subjected to radiological assessment with plain radiography of the wrists and high-resolution ultrasonography, and magnetic resonance imaging (MRI) in some complicated cases. The analysis of data has been performed with SPSS 26. Continuous variables were in the form of mean + SD and categorical variables were in the form of frequencies and percentages. When appropriate, one-way analysis of variance (ANOVA), Chi-square and correlation analysis were used. A p-value of less than 0.05 was deemed as statistically significant.

Results: Of 120 patients, 74 (61.7%) were women and that of 40-49 years was the largest (36.7%). Repetitive manual work (35.0%) and clerical/computer work (28.3%) were the most common occupations. The most common presenting symptoms were nocturnal paresthesia (85.0%), numbness of the median nerve area (80.0%), and pain at the wrist (78.3%). The compression test, conducted by Durkan, was the most positive (82.5%), followed by the test conducted by Phalen (78.3%), and the sign of Tinel (73.3%). In 33.4 percent of the patients who received ultrasonography, there was a median nerve cross-sectional area of ≥15 mm 2 whereas palmar bowing and high flattening ratio was observed in 58.3 percent and 53.3 percent respectively. Electrodiagnostic severity significantly correlated positively with the duration of symptoms, cross-sectional area of the median nerve, thenar weakness, radiographic changes and work-related disability (all p<0.001). Medico-legal concordance between clinical observations, electrodiagnostic, and imaging studies was found to be high (65.0% in patients) and probable permanent partial impairment was (21.7) found in patients.

Conclusion: Multidisciplinary assessment involving orthopaedic examination, electrodiagnostic testing and radiological imaging is a reliable and objective methods of diagnosing carpal tunnel syndrome and severity measurement of the disease. Ultrasonography was found to be closely correlated with results of electrodiagnostic, and the radiological test was also valuable as further evidence of structural abnormalities to consider in the context of secondary CTS. The high scores of correspondence between the clinical, electrophysiological, and imaging findings support the application of integrated assessment to the discrimination of disability and medico-legal practice. This practice is more effective in enhancing accuracy of diagnosis, objective assessment of impairment of functional activity, and in boosting forensic judgment in patients with suspected carpal tunnel syndrome.

Myositis-Associated Interstitial Lung Disease: Focusing on Anti-synthetase Syndrome and MDA5-Positive Dermatomyositis

Ibadullah Tahir — 2026-07-30

Background: Myositis-related interstitial lung disease (ILD) is a devastating presentation of idiopathic inflammatory myopathies, and not all patients respond in a similar way to this condition. Anti-synthetase syndrome and MDA5-positive dermatomyositis are identified subtypes that have an independent pulmonary involvement. The purpose of the study was to compare clinical, functional, radiologic and outcome characteristics of these two subgroups.

Methods: A retrospective cohort study was carried out in a tertiary care center(POF Hospital Wah Cantt) in the time frame of January 2010 to December 2022. Adult patients with positive anti-synthetase syndrome or MDA5-positive dermatomyositis were taken into account. Medical records were reviewed to extract demographic information, clinical characteristics, pulmonary function tests (FVC and DLCO) and high-resolution computer tomography (HRCT) severity scores, and mortality outcomes. The SPSS version 26 was used to analyse the data and p < 0.05 was taken to be statistically significant.

Findings: 120 patients were studied (50 anti-synthetase syndrome, 70 MDA5-positive dermatomyositis). There was no difference in mean age (50.96 vs. 51.47 years). Both groups had restrictive lung disease and had a poor diffusion capacity (mean FVC: 71.91% vs. 66.53%; mean DLCO: 53.92% vs. 56.05%). The severity of HRCT was similar, but with slightly higher proportions of patients with severe involvement in MDA5-positive dermatomyositis. The MDA5-positive dermatomyositis group had a higher mortality (29% vs. 16%). The overall gender balance was equal with slight female dominance in anti-synthetase syndrome and male dominance in MDA5-positive dermatomyositis.

Conclusions: MDA5-positive dermatomyositis and both anti-synthetase syndrome are characterized by high restrictive lung disease and diffusion impairment. Nonetheless, MDA5-positive dermatomyositis has a greater severity and mortality of HRCT, implying a more aggressive ILD phenotype. These results highlight the issue of early detection and surveillance of pulmonary involvement in myositis patients especially when they are MDA5 positive.

Student Satisfaction Among Transitional Doctor of Physical Therapy Students in Lahore, Pakistan: A Cross-Sectional Survey

Arwa Majid — 2026-07-30

Background: An important measure of educational experience satisfaction is student satisfaction, which may offer institutions valuable information to help in determining strengths and areas for improvement. Transitional Doctor of Physical Therapy (tDPT) programs were created for advanced study by physiotherapists, but there is little data regarding student satisfaction with various aspects of a tDPT program in Pakistan.
Objective: To assess satisfaction among the Transitional Doctor of Physical Therapy students in Lahore, Pakistan.
Methods: A cross-sectional observational study was carried out on the students of Doctor of Physical Therapy transitional programmes in Lahore. Convenience sampling was used to select participants. A structured questionnaire, that follows the student satisfaction framework developed by Elliott and Shin, was employed for data collecting. The measure of satisfaction was for a five-point Likert scale of very dissatisfied to very satisfied. The data were analyzed descriptively by frequencies, percentages, means and standard deviations.
Results: The total number of students was 76. The satisfaction levels were stepped up high as 69.7% of the students were very satisfied and 19.7% very satisfied with teaching and supervision. Likewise, 75.0% expressed satisfaction or very satisfaction with the curriculum, and 88.2% expressed satisfaction or high satisfaction with the supervisor's knowledge of research procedures. By contrast, the admissions policy was very uncertain with 56.6% of students choosing the undecided category. The overall satisfaction rate for students was 73.6% very satisfied or satisfied.
Conclusion: The majority of students experienced positive experiences regarding the curriculum, teaching and supervision, research assistance, and infrastructure and professional skills development. On-going student feedback, along with exploratory, qualitative research, may assist institutions in pinpointing areas of administrative and assessment practices that need improvement.

Systemic Immune-Inflammation Index and Coronary Microvascular Dysfunction in Patients with Non-Obstructive Coronary Arteries

Benazeer Mikrani — 2026-07-30

Background: Coronary microvascular dysfunction contributes to ischaemic symptoms in individuals with non-obstructive coronary arteries. Systemic inflammation might lead to endothelial dysfunction and irregular coronary microvascular resistance. The systemic immune-inflammation index is an indicator obtained from the numbers of neutrophils, lymphocytes, and platelets.

Aim: To assess the correlation between the systemic immune-inflammation index and coronary microvascular dysfunction in individuals with non-obstructive coronary arteries.

Methods: This cross-sectional investigation included 150 individuals receiving coronary angiography at Mayo Hospital Lahore between June 2024 and June 2025. Individuals suffering from obstructive coronary artery disease, acute coronary syndrome, ongoing infections, inflammatory conditions, cancer, or diminished left ventricular ejection fraction were omitted. Coronary microvascular dysfunction was characterised by a coronary flow reserve of less than 2.0, a microvascular resistance score of 25 or higher, or both criteria. The systemic immune-inflammation index was determined by multiplying the platelet count by the neutrophil count and then dividing by the lymphocyte count.

Results: Coronary microvascular impairment was detected in 62 individuals (41.3%). The median systemic immune-inflammation score was elevated in individuals exhibiting dysfunction compared to those with intact microvascular function (821 vs 487; p<0.001). The index exhibited a negative correlation with coronary flow reserve (r=−0.49) and a positive correlation with microvascular resistance (r=0.53), both p<0.001. Following multivariable correction, every 100-unit increment continued to be independently linked to dysfunction (adjusted odds ratio 1.18; 95% confidence range 1.09–1.28). A threshold of 620 demonstrated 80.6% sensitivity and 73.9% specificity.

Conclusion: The systemic immune-inflammation score was independently linked to coronary microvascular dysfunction and might aid in risk classification for individuals with non-obstructive coronary arteries.

Discordance Between Biological and Chronological Age as a Predictor of In-Hospital Functional Decline

Farah Shafi — 2026-07-30

Background: Biological age may reflect physiological reserve more accurately than chronological age. This study evaluated whether discordance between biological and chronological age predicted in-hospital functional decline among older medical inpatients.

Methods: This prospective observational cohort study included 120 patients aged 60 years or older admitted to a medical ward of General Hospital Lahore between February 2024 and February 2025. Biological age was estimated using the PhenoAge model based on chronological age and nine routine biomarkers. Age discordance was calculated by subtracting chronological age from biological age. Functional status was assessed using the Barthel Index before admission and at discharge. Functional decline was defined as a reduction of at least 10 points. Multivariable logistic regression identified independent predictors.

Results: The mean chronological age was 69.1 ± 6.8 years, while the mean biological age was 74.0 ± 9.4 years. Functional decline occurred in 39 patients (32.5%). Patients with decline had greater age discordance than those without decline (9.4 ± 7.0 versus 2.7 ± 5.4 years; p<0.001). Functional decline occurred in 11.8% of patients without acceleration, 26.3% with moderate acceleration, and 52.1% with marked acceleration. Each five-year increase in age discordance independently increased the odds of functional decline by 56% (adjusted odds ratio 1.56; 95% confidence interval 1.22–2.00; p<0.001).

Conclusion: Positive biological-age discordance independently predicted in-hospital functional decline. Biological-age estimation may improve early identification of vulnerable older patients and support geriatric, nutritional, mobility, and discharge interventions.