William E. Morgan, D.C.

Healthcare providers have long strived to form integrative teams under the banner of patient-centered care, while unintentionally excluding the most important person in the team: the patient.  Patients have the greatest stake in their care and ought to be included as partners in their own care.  Noncompliance of patients can be linked to their lack of team inclusion and involvement in decision-making.  The old dictatorial relationship of the doctor-patient needs to be replaced with one of patient empowerment, informed choices, and self-efficacy.

Modern medicine clearly has the ability to damage a patient’s perception of autonomy:   “Mrs. Jones, you have breast cancer.  You need to have a mastectomy and begin radiation therapy immediately.”  “Mr. Brown, your blood pressure is too high we need to put you on this prescription.”   When health problems arise, self-determination is stripped from the individual.  Patients are not told options; they are given doctor’s orders.  Certain factions of chiropractic are also guilty of stripping patients of their self-efficacy.  When a patient is prescribed a long program of passive chiropractic care (care provided for the patient without the patient being actively involved), the patient develops an unhealthy dependence on the chiropractor.  

Helping Set Patient Treatment Goals

All patients have goals.  Even uncooperative patients have goals; it's just that their goals are different than the doctor’s goals.  Ideally the patient’s and the doctor’s goals meld and are recorded in the chart notes.   A physical therapist friend of mine likes for the patient to write down his or her goals for treatment and sign them.  “I would consider my treatment successful when I am able to hold my granddaughter without pain.”  Or “… if I could return to work with less than 3/10 pain (as measured on an analog pain scale).”  Ensure that optimistic but realistic goals are set, and do not force your goals upon the patient.  When the agreed-upon goals are met, a follow-up visit should be arranged to determine the need for future care.

Empowering the Patient

It is important to acknowledge the patient’s intuitive self-awareness in the healing process.  Remember that they are the world's foremost authority on themselves.  Keep them involved in their own management.  Following these tenets of patient empowerment will promote self-efficacy in your patients:

1. Doctors should not manipulate patients to achieve the doctor’s goals.
   
2. Most chronic conditions are really managed by patients not doctors.  Help the patient to understand how to manage their condition effectively.  Certainly wellness is maintained much more through wise conscious decisions of patients than through the intervention of the doctor.
   
3. Doctors should give patients options not commands, and make sure the patient is aware of the consequences of their choices.   With more knowledge patients will know enough to avoid making bad decisions.
   
4. Empower patients with education.  It is your job as a doctor to provide clinical expertise and education.  It is difficult for patients to make decisions about things that they don't understand.  A properly educated patient will want to work together with their doctor to maximize outcomes.
   
5. Be the doctor.  Strive for patient empowerment, but certain circumstances require that you speak firmly with the patient.  Inform patients of the consequences of not following your advice.  If you see self-destructive behavior in the patient, you may insist on a behavioral health consultation; or if the patient displays ominous findings, you may insist on a specialty consultation.

Studies have shown that patients with perceptions of self-efficacy are healthier that those with a spirit of dependence.   Self-determination and the ability of a patient to make informed healthcare decisions lie at the heart of healing.  All partners in modern integration should support patient efficacy and reduce patient-provider dependencies.