Monday, August 30, 2010

Can Clinicians Empower Patients?

On first blush, my answer to the questions, "Can clinicians empower patients?" was an unqualified "Yes"!.

Recently, however, on my Facebook page, I posted a link to a NY Times book review of "The Empowered Patient" by Elizabeth Cohen. Cohen, a CNN journalist, writes about her personal experiences dealing 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 arm themselves to increase their chances of getting the care that they, or a loved oned, need.

My posting led to a lively discussion among some of my Facebook friends about the term, empowerment. Eleni Chambers, a UK-based expert in self-management strategies, stated that clinicians can't actually empower patients, just support or enable empowerment. Some patients, she argues, 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.

However, I do believe that I, as a clinician, can empower many of my patients. For one, I can share the "power" of choosing tests, procedures and treatments. I can collaborate and partner with patients, rather than simply prescribe, direct or even advise. I can also encourage my patients to let me know their ideas, expectations, feeling and goals, so I can better tailor my recommendations for them. Once I have a good idea about what a patient wants and needs, I can offer options and choices and help my patients to consider the pros and cons for each. Others have referred to this process as shared decision making. Ultimately, patients decide, unless of course they have a condition that limits their capacity to make rational decisions. Sure, some patients, particularly some older patients, want me to decide or direct therapy. That is ok, I am happy to do that if the patient prefers that I take the lead in picking a treatment.

However, I also know that patients are more likely to follow through with treatment when their autonomy is supported and respected and they are provided with choices and options. (See expecially the work of Geoff Williams, MD, PhD, and other proponents of Self-Determination Theory - a topic of a future column).

I agree, however, that there are limits to what I as a clinician can do to "truly" empower some 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 control over. As Jessie Gruman, PhD, of the Center for Advancing Health (CFAH) has noted (see link in my link section), it may be better to use the terms "prepared" patient or "engaged" patient, rather than "empowered" patient. Activated, a term championed by Judith Hibbard, is another way of framing the approach. See the CFAH website and its associated Prepared Patient Forum (see my link to this site) for lots of useful tools, resources and strategies for arming patients, their families, and other advocates.

Whatever the term, helping our patients to more fully participate in care provides all sorts of positive benefits!


  1. Michael,
    I agree with you 100% and therefore think that
    "The Empowered Patient" is a book for those people who want help in dealing with the medical establishment. Too often, patients who want to know more or understand more are stymied by either the physician or the system. Ever try to talk to a doctor about options when dressed in nothing but a dressing gown? The book is obviously not necessary for someone who prefers to be less involved in treatment.
    When I once asked a physician some questions about a procedure, he asked "don't you trust me?" I had just met him and I wanted to know more. In fact, I had not even made up the questions, but found the questions on line.
    I guess some professionals prefer to keep their patients in the dark. I have found that the professionals who take pride in their work are the ones most happy to address concerns or as you say "empower" a patient (whether, just as you say, it is choosing tests, procedures and treatments, or other ways of collaborating).

  2. PS
    I just realized that your whole blog concerns itself with patient advocacy and relationships!
    Did you check Rita Charon's works? I think you would appreciate her approach to patients.

  3. Hi Linda. Thanks for your coments. Yes, I agree. Clinicians can't simply expect patients to trust them. Trust develops in the context of communication and collaboration and the experience of working well together. I also agree that clinicians who are more confident in their knowledge and skills are more likely to support patients in their efforts to learn and do more.

    And Yes, I know Rita. She is a wonderful clinician, a fabulous writer and one of the "founders" of the emerging field of Narrative Medicine.