I don’t need YOU to empower ME. thanks all the same
Words like “compliance” and “adherence” are now seen to reflect the authoritarian health structures of yesteryear and have been abandoned in favour of “patient empowerment” and motivational interviewing.
At least with compliance you knew where you stood-the doctor expects you to do as he says. The notion of “empowerment” is a slippery little sucker* but in a twist worthy of George Orwell’s 1984, the term is often used to mean “empowered to make healthy choices” it’s a sort of doublespeak in which patients are, it seems, being empowered to become compliant with instructions aka advice provided by health professionals.
The Oxford English Dictionary defines “empowerment” as “Give (someone) the authority or power to do something”
The assumption is that Health Professionals need to give me the power to make decisions about my own body. This is an assumption I utterly reject and what’s more it flies in the face of hundreds of years of medical ethics in which “informed consent” was the key concept in patient choices. Informed consent is a concept that respects the patients’ rights and recognises that it is the patient who must make decisions over what happens to their body.
We don’t need to be empowered, we hold all the power already. It is up to HCPs to give us the INFORMATION we need to make informed choices, what we do with that information is entirely up to us. It is almost scandalous that health care professionals are creating a language that denies we have the right to control what is done to and indeed, what we do with out own bodies.
I want my health professionals to give me sufficient information about the risks and rewards and alternatives of any treatment or intervention they might be recommending. So they might recommend I walk for 30 minutes a day, I don’t need them to empower me to make a decision to do this, it’s me that’s going to put one foot in front of another, or not, get up an hour earlier or leave work early to do it, not them. I’d like them to tell me why they are recommending this, what benefits it provides to my health and wellbeing, what the risks are and how to ameliorate these (it’s not as silly as it sounds as any change to exercise with type 1 diabetes requires adjustments) and whether other exercises would be more or less beneficial given my particular health profile.
It’s my body, my health and I will make the decisions and it will be me and me alone who bears the consequences. I manage my diabetes, I set my insulin basal and bolus rates, I decide what and when I eat and how and when I exercise. Nobody empowers me to make these decisions. I look to health professionals to give me information that might help me make those choices but the choices always have been and will remain MINE.
*It should be noted that patient empowerment remains a poorly defined concept in health literature, and despite being quite ubiquotous it is used to mean different things by different people. Aujoulat et al note that “ The word ‘‘empowerment’’ is poorly defined, with authors often referring to some anticipated outcome, such as self-management or self-efficacy to explain what they mean, rather than defining what ‘‘empowerment’’ according to its very nature.” Isabelle Aujoulat a, William d’Hoore, Alain Deccache. Patient empowerment in theory and practice: Polysemy or cacophony? Patient Education and Counseling xxx (2006) xxx–xxx