Is Patient Empowerment a Myth?

Pamela L. Wible, MD

Disclosures

October 11, 2017

In This Article

Who Defines Patient Empowerment?

Patient empowerment is best defined by the patient, not the doctor or the health system. "I'm going to empower you" is not something a physician can actually do for a patient anyway.

Maybe empowerment, like curiosity and assertiveness, is innate. You either have it or you don't.

High empowerment may be found in urban dwellers who are educated, insured, and of higher socioeconomic status. Risk factors for low patient empowerment are lack of education, illiteracy, lower socioeconomic status, being elderly, being a child, being uninsured, residing in a rural area, and living in a community with little or no Internet access.

Whereas some physicians complain about patients arriving with pages of Internet research, other doctors (such as my physician friend who works at a community health center) have never encountered such a patient. "Physician opinions about empowered patients largely define who they treat," explains one doctor.

Not all doctors want empowered patients. Not all patients want to be empowered.

"I believe it very important to assess patients' ability to be active participants in their own care," claims one physician. "It can be harmful if they are making uninformed decisions or decisions based on misinformation. For some patients, having access to their medical record and to Internet information can be quite helpful, whereas for others, they can get so bogged down by the amount and/or quality of the information that they become paralyzed or require significant clinical resources and time to move forward or make any decisions."

"The vast majority of medically naive patients cannot distinguish the false, misleading, and profit-motivated medical information from the clear and factual resources available from reputable sources," states another doctor. "The well-informed few facilitate a beneficial discussion with their healthcare providers. The rest confound that process to varying degrees."

Why Does Patient Empowerment Seem Like Such a Struggle?

One in five physicians (21%) find patient empowerment annoying, according to the Medscape poll. Many physicians (39%) said that patients' research made care more difficult (only 24% said it made care less difficult). Fifty-three percent of physicians said that at least one half of their patients should not be empowered.

One in five physicians find patient empowerment annoying.

"The common theme in the patients that drive me up the wall is a lack of trust and mutual respect," shares one physician. "[I have a problem] when patients say, 'I've done my research,' and use that to demand a treatment or to decline what I think is a very good thing (eg, vaccines). But I have no problem when someone says, 'I've done my research; what do you think about...?' And we have a dialogue about it and what I think is a good idea and why."

She goes on to explain, "I made the mistake of posting these comments on Facebook and I was inundated with hate for physicians. I was accused of wanting to make patients 'better sheep' and insinuating that I was 'smarter than my patients, which is condescending.' I'm sorry that I believe that 7 years of study and 10 years of experience is worth more than a 10-minute Google search."

The genesis of these Facebook accusations is the inherent and inescapable power differential in the doctor/patient relationship. Doctors hold more power than patients. (Although online reviews are certainly giving patients some much-feared power.) Some patients would be offended by doctors offering to empower them. Would that remind patients that they are powerless and somehow less intelligent or capable than doctors?

The fact is, most patients want simple solutions to complex problems. In my residency, I was always taught to deliver medically complex information at a fourth-grade level (sans medical jargon). Now doctors must do this in 7-minute visits for highly distracted patients with shorter and shorter attention spans (some spend part of their visits texting on their cell phone. Heck, I had a real estate agent close a sale on her cell phone during her Pap smear!).

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