Patient empowerment, self-management, e-health, participatory medicine, shared decision making: these notions are the buzz in some healthcare circles and with governmental policy makers. They are advocated to be a solution to keep health care costs in check while facing the ‘silver tsunami’ in the coming decenniums. Yet in real life, here in The Netherlands, they are still a far cry from reality. Empowered patients are the exception. Health care providers who really take the time to help their patients to empower themselves are even scarcer. Health care consumers pay a lot of money, yet have almost no influence on how it is spent by the government.
Most patients do not ask for their medical records or research their treatment options. Most patients do not take their exercise or medicine as prescribed. Most patients do not stop overeating when their doctor tells them this could hold off diabetes. Or drink less alcohol and eat less fatty, sugary and salty foods. At the same time, most doctors do not take the time to fully inform their patient about all aspects of their disease and treatment. Most doctors do not involve their patients in the decision making process. Most doctors do not take the whole patient into account during treatment. They treat the disease without addressing the patient’s emotional and psychological needs. They do not make full use of the important role his family and extended social system can play in care and recovery.
Change will come
However, a change is happening. Yes, it is mostly happening amongst younger, well-off, well-educated people. But thanks to the internet, more and more people seem to take an active interest in their own health and disease. Similar to developments in other public domains, the absolute power of the all-knowing, expert authority figure, the doctor, is challenged. A younger generation of doctors – nowadays more and more female – is also challenging traditional ideas about doctor-patient interaction. This is a good thing. A more equal setting between doctor and patient is created. It will ensure more realistic expectations of what doctors and medicine can do. At the same time, more involved patients are more likely to comply with a treatment they feel and know they have chosen themselves.
Health care providers: manage expectations
What can all parties involved do to make the transition to participatory medicine and patient engagement? Health care providers have a responsibility to be willing to change attitudes and work methods; to improve their communication skills; to be open to new approaches like holistic views that include complementary care; to value and show their own emotions and compassion. Change will have to revolve around what clients or patients want and need. The only way to find out what they want is simply ask. Managing patients’ expectations is the key tool of a successful health care provider. Openness to feedback from patients is critical in that process.
Patients, take responsibility
When I say patients, I mean healthcare consumers, which is all of us. I acknowledge that many people do not want to think about getting ill and needing health care while they are healthy. That is why they sit back and let a lot of political decision making just happen. Just like how most of them just expect their doctor to give them a simple medicine to make everything better. But these are crucial times. Today, decisions are made that affect health care in many years to come. I am part of a generation that will be old at the height of the silver tsunami. If I do not get involved with my personal health and with the future of healthcare now, it might be too late by the time I’m old and grey.
Government: participatory policy making
The Dutch government wants its citizens to take an active role in their health and adopt a healthy lifestyle. At the same not much is done to support this. Dire economics lead to more financial dieting. A comprehensive vision for the future of Dutch healthcare is lacking. Investments in disease prevention and lifestyle programs are as good as absent in policy and budgets. It is time for a completely new approach that puts health care consumers in their rightful place. They spend a substantial part of their income on our healthcare system, yet today, they still have very little say in how it is organized and financed. And they never get asked if it meets their needs. Maybe engaging in some participatory policy making might be just what the doctor prescribed!
This article was written for the website of TEDxMaastricht and published there on 16/01/2011.
© 2011 Harriët Messing