Imagine you live in a village in the Pyrenees of Lleida. The only way to contact the nearest doctor, who makes daily rounds in the regional capital, is by phone or through an online consultation . However, the health center’s switchboard is overwhelmed. You have a mobile phone that allows you to make video calls with your family, but you don’t know how to connect with your doctor. You have no choice but to get in your car and travel there.

Now imagine you are an endocrinologist with over 35 years of experience, an excellent professional who has improved the lives of many people. The digitization of medical records has become a double-edged sword for you. You understand the advantages of having the patient’s entire history available at a glance, but you are so focused on recording the data and reviewing everything that you have stopped providing proper care to your patients.

She feels she is becoming dehumanized, which leads to emotional exhaustion and burnout in the later stages of her working life. This causes her anxiety.

These two examples illustrate how the digitization of the healthcare system has aspects that are sometimes not presented clearly and transparently. Its advantages are undeniable: telemonitoring tools , diagnostic assistants, virtual consultations, and access for expert professionals to remote regions have emerged. But like all technological and scientific developments of the last century, we must always pay attention to its side effects. The goal is not to halt this development, but to humanize it and consider its potential consequences.

And who gets left behind in this digital race? It’s easy to answer that question: the usual vulnerable groups become even more vulnerable with new technologies in most cases.

Of gaps and biases

The digital divide has been described on numerous occasions. For example, the digital health team of the Catalan Society of Family Medicine (CAMFIC) has emphasized the importance of addressing the digital determinants of health to ensure that everyone has access to the benefits of technology.

Beyond technological sedentary behavior or the fear of using the thousands of data points generated in the health field, the lack of technical capacity and digital knowledge remains, today, one of the most prevalent digital determinants of health, as shown by a recent study from the World Health Organization .

It should be added that we also face a gender gap, a structural problem in traditional medicine that has its equivalent in the digital sphere. The problem goes beyond access to healthcare services: algorithmic biases, stemming from unbalanced training datasets, can not only replicate but even amplify existing inequalities, as demonstrated by the UNESCO report *I’d Blush if I Could *.

If artificial intelligence systems are trained primarily on data from men—due to the historical underrepresentation of women in research—their diagnoses and treatment recommendations may be less accurate for women. For example, the symptoms of a heart attack or stroke can differ in female patients , and an algorithm not trained to recognize these differences could miss them. Thus, tools designed to be objective could end up perpetuating the “Yentl syndrome ,” in which women receive fewer diagnostic tests and less timely treatment.

Digital literacy for patients and professionals

In the face of these challenges, digital literacy is a fundamental tool. This literacy is defined as the skills and knowledge essential for using technology, including the internet, computer applications, and mobile devices.

But this concept isn’t only applicable to the general public; it also applies to healthcare professionals. The phenomenon of technostress has been described and affects those professionals who, despite recognizing the importance of new technologies in clinical practice, find themselves falling behind. This feeling of powerlessness and lack of control over their practice ultimately leads to stress, anxiety, and professional burnout .

That’s why promoting training is essential. Digital transformation won’t be complete if all professionals don’t feel comfortable with it. It’s important to remember that the shift from paper-based to electronic medical records has been rapid and unstoppable.

What is digital justice?

Talking about justice in the realm of digital health means striving for a realistic vision that goes beyond egalitarian or equitable policies. We cannot simply provide mobile phones to all citizens so they can connect to the internet, or simply provide devices with large keys. We must undertake educational initiatives so that citizens can exercise their digital autonomy with quality and dignity.

This isn’t a question of ageism . The 65-75 age group already masters many digital tools. But in 10 years, such rapid evolution is expected that we will have to learn at breakneck speed, because younger generations will also have become obsolete. Digitalization should empower patients , enabling them to better manage their health and related data.

In this constant evolution, citizens must be involved in the design of new applications and platforms, from a bioethical perspective. In fact, we have proposed the term cyberbioethics to address all the ethical dilemmas linked to digital health and artificial intelligence.

Ultimately, we must be clear that the fundamental question is not the what, the how or the why, but the what for and for whom.

Author Bios: Oriol Yuguero is an Emergency Physician and Researcher at IRBLLEIDA in the area of ​​Emergency Medicine. Associate Professor at UOC and ULL at the University of Lleida and Marta Aymerich is Director of the UOC-eHealth, research center in digital, human and planetary health at UOC – Universitat Oberta de Catalunya