Configuring symptoms: experiences from an internet-based self-help programme for persistent physical symptoms in general practice

This article explores the introduction of the internet-based self-help programme “My Symptoms” into Danish general practice. The programme aims to assist patients and general practitioners (GPs) in managing persistent physical symptoms (PPS) such as pain, fatigue, gut trouble, and dizziness. These symptoms affect a significant part of the population, yet they are rarely explained by a pathophysiological diagnosis. The article is based on ethnographic fieldwork in four general practice clinics in the Central Denmark Region and 31 semi-structured interviews with GPs and patients engaged in the programme. Inspired by work emphasizing technologies-in-practice as multidirectional, that is, shaped through reciprocal interactions across actors and settings, we examine how this programme subtly co-constitutes symptoms, practices, and relationships between patients and GPs. Rather than taking either a patient or a clinician perspective, we analyse engagement across both groups and across of both home and clinic. Through this lens, we explore three interrelated themes in the making of PPS: primary care, everyday life, and the redistribution of responsibilities. By attending to the fluidity and adaptability of PPS and programme engagements, we show the sensemaking and reconfiguring practices required to transform digital health programmes into meaningful care practices. The analysis, therefore, complicates the dominant promises of a digital transformation of healthcare by showing how technologies define and constrain specific care practices as possible. This raises critical questions about shifting responsibilities and the distributed work of self-help technologies in contemporary healthcare.