Empowered to be Compliant?

Melinda Seed writes for Twice Diabetes
Melinda Seed writes for Twice Diabetes


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

4 thoughts on “Empowered to be Compliant?

  1. As a health professional, I see empowerment to be allowing a person to make the decisions. In life and health we can all make decisions around our health but it is our right to make them and we don’t need to be “unsupported” if the health provider does not agree with our decisions.

    However, in my experience as both a person and an educator, sometimes I just need a bit of a hand to make the change. As an educator I see it as my duty to provide that bit of a hand if someone wants it. It is a fine line to walk and truly the challenge for the educator is to offer the hand without grinding the toes of the person we are working with.

    I see the empowerment model as better than the old “do as I say” model, as it is more “what do you think and can I help in any way?”

    1. Thanks for your comment Catherine and for defining what you mean by empowerment. Your definition does indeed, sound more helpful than the compliance model. I can’t help wondering, though, for those of us who have had type 1 diabetes for decades and are highly educated what capacity a DNE or any HCP for that matter has, to give us a hand. I know how to manage insulin doses, I’ve read all the guidelines on t1D mgt and I know all the stuff about diet, contradictory and subject to change as it is. Now it would be enormously helpful if health professionals could give me a hand by being a personal trainer who understood t1d, could come to my house and do the suggested 3am bsl without waking me and also be a gourmet chef of carb-counted, high fibre, low carb, low fat meals but failing that I don’t need assistance with diabetes management. Of course I need complication screening and mgt but I discount that from the empowerment/compliance model.

      You’re obviously a really dedicated and thoughtful D educator Catherine, what do you see as your role in using the empowerment model to help us “old salts” who’ve been around a long time?

      It just struck me that we had a similar discussion around Kate’s post http://twicediabetes.com/ditched-my-diabetes-team/ so I just checked-it’s good to see we’re consistently grappling with the same issues.

  2. Yes, I think it is the same discussion. For those with t1 who have walked the miles with diabetes, maybe the only use of an educator is to have a natter with some one who has an idea of the difficulties of managing diabetes. Peer support of course does provide that as well.

    Given that our daily lives (educators) revolve around diabetes in both reading the articles and talking to those with diabetes, it may be that we may something useful to share with you or you may provide something useful that we can share with someone else.

    I keep going back to the collaborative model and I am disturbed to see how far away we (educators) appear to be. It could be that we educators only get to see those who are satisfied and read on blogs what is happening with the rest!

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