I may not know how to tell the difference between an empowered patient, an engaged patient, or an activated patient. But I do know that fastest way to disempower, disengage, and de-activate any patient is a trip to the doctor’s office or the hospital. A visit to an average primary care physician (or specialist) is to an empowered/activated/engaged patient what Kryptonite is to Superman. It will stop all but the strongest willed patients dead in their tracks.
We patients have been socialized that way. Think about your earliest memories of “going to the doctor.” For me, I remember my Mom taking me to the Pediatrician. Early on I learned by watching the interaction between my Mom and the doctor that they each had a role. The doctor’s role was that of expert – he spoke and my Mom listened. I was there just to have one or more extremities twisted and prodded. And oh the medicinal smell…
Things haven’t changed much in the 40 years since I was a kid sitting in Dr. Adam’s office. Well maybe the smell isn’t as medicinal. But the roles played by doctors and patients haven’t changed much. Studies over the last 30 years consistently demonstrate this unfortunate reality. If you were to believe the admonitions of the NIH, AHRQ, hospitals, pharma and every WebMD-look alike, you would think that patients these days would be more involved in their visit…asking questions, sharing information and making decisions. But as most physicians will attest…most patients don’t have much to say in the exam room anyway. And the longer they have to wait before being seen, the less patients are likely to bring up the few questions they wanted to ask.
This is a huge problem. It belies conventional wisdom that the key to fixing health care begins and ends with changing patient behavior. If only we could get patients to be more compliant, if only patients would do what I tell them, blah, blah, blah.
Physician behavior, specifically, the way they think about, relate to and talk to patients needs to change (no e-mail, text messages and social media will not solve this problem)…before long term, sustainable change in patient behavior is possible.
If you look at most theoretical models underpinning patient empowerment, patient activation, etc., you will see that none of them factor in the impact of the care delivery context, e.g., doctor’s office, hospital room, surgery suite, or pharmacy, on patient behavior. A patient considered Stage IV (Activated) on the Patient Activation Model (PAM) or the “Action Phase” using Stages of Change would “crash and burn” if their doctor is among the majority who employ a traditional physician-dominated, biomedical communication style or “bedside manner.”
How empowered, activated, or engaged can a patient be if they don’t know when to open their mouth, are ignored , or fear taking up too much of the doctor’s time?
Yes you can and should probably change physicians…but since so many physicians “practice” the same way…even supposedly Patient Centered Medical Homes…what’s the point?
Until health plans and providers take a serious look at incentivizing physicians to become more patient or relationship centered, behavior change efforts directed at patients can only accomplish just so much.
That’s my opinion. What’s yours?
Cegala, D. An Exploration of Factors Promoting Patient Participation in Primary Care Medical Interviews. Health Communication, March 2011. 1–10, 2011.