Can Clinicians Empower Patients?
b Michael Goldstein
About a year ago, the New York Times published a book review of “The Empowered Patient” by Elizabeth Cohen. Cohen, a CNN journalist, wrote about her personal experiences with medical crises and what she learned about the need to advocate for quality health care. Her book provides suggestions about how patients can prepare and advocate for themselves to increase their chances of getting the care that they, or a loved one, need.
In response to the NYT review, I wrote on my Facebook page about the role that clinicians can and should play to empower patients. My posting led to a lively discussion among some of my Facebook friends about the term, empowerment. Eleni Chambers, a member of MPN Forum and an international expert in self-management strategies, argued that clinicians can’t actually empower patients, just support or enable empowerment. Some patients, she noted, don’t want to be empowered, and others have serious barriers to empowerment (e.g., lack of access, low socioeconomic status) that can’t be easily addressed by clinicians.
I agree that many patients don’t want to be empowered. Published results of patient surveys indicate that a large proportion of patients prefer to receive information from their doctor rather than seek it out themselves and, although almost all patients want their doctors to ask their opinions, more than 50% of patients prefer that their doctor make final treatment decisions. However, I believe doctors and other clinicians can act in ways that increase the likelihood that patients will want to participate more actively in care.
Encouraging involvement in care is not just the right thing to do. Research studies have shown that patients who are offered choices and options are more likely to follow through with treatment, take prescribed medication and achieve better control of their chronic conditions. Patients who are encouraged to ask questions and prepare for their visits are not only more satisfied with their care, they actually achieve better health outcomes.
When I was still treating patients, I provided patients with options for tests, procedures and treatments and encouraged patients to make decisions based on their preferences. Though I was willing to offer my opinion about what might work best for them, I needed to know my patients’ values and what mattered most to them. Some of my patients wanted to have their conditions treated as aggressively as possible to control symptoms and reduce the risk of complications, while others preferred to limit treatments because of concerns about the short and long-term effects of the treatments themselves. Some have referred to this process as shared, or informed, decision making. Unfortunately, research has shown that most physicians infrequently devote the time and effort required to meet criteria for informed decisions. Moreover, when I gave my patients choices, many folks opted to try “non-medical” strategies, such as diet, exercise and stress management before embarking on medication management.
I actively encouraged patients to use these “self-management” strategies even when they decided to take medication, as these behavioral strategies have benefits beyond their direct impact on chronic conditions. Patients who learn to use self-management strategies became more confident and self-reliant and this, in turn, increases their feelings of well-being and satisfaction. Moreover, people who exercise and eat wisely have reduced risk for other conditions, such as diabetes and heart disease and even some cancers.
I agree, however, that there are limits to what I as a clinician can do to empower my patients. I can’t empower a person who doesn’t want to be empowered, and I can’t overcome barriers that neither I nor the patient have direct control over, such as low socio-economic status and limited access to a safe environment. Despite these limitations, I remain committed to helping clinicians to empower, prepare and activate their patients by offering tools, resources and referrals to programs that address and support “self-management”. I encourage you to seek clinicians who share this view, and/or seek resources and programs outside mainstream medical care that provide the opportunity to become more empowered. MPN Forum is one such resource, thanks to many of you. I am proud to be both a contributor and user of MPN Forum. For other resources, see the New Health Partnerships website – http://www.newhealthpartnerships.org/ or the Prepared Patient Forum, cited in last month’s column.
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