Disempowering our patients

Neil - Doctor of PhysiotherapyBlog, Health, Physiotherapy0 Comments

Fortunately, I’ve only been a patient in hospital a handful of times. Five times in theatre; twice with knee surgery, once for a skin graft for cancer, and twice for another procedure that made Endone my best friend. I’ve twice been admitted via the Emergency Department, once kept in overnight on a drip and another narrowly missing out on being zapped with a defibrillator to stop atrial fibrillation. Thankfully the drugs eventually worked and I didn’t need zapping.

When you’re admitted to hospital you typically have very little control over what you do and what’s being done to you. Being anaesthetised and unconscious is the ultimate relinquishment of control.

Prof Peter O’Sullivan shared this Tweet over the weekend: “The greater skill is to empower people to be in control of their pain and chase valued goals without reliance on passive therapies.” In another thread he also suggested that *Physios* need empowering too in regards to ‘crossing the chasm’, which is Dr Jason Silvernails’ ‘thing’. His latest video on the topic was live via Facebook on the Trust me I’m a Physiotherapist page here this morning and it’s already been watched almost 11,000 times in the first 9hrs! My advice was to JUMP!

Along a similar theme of empowering people, Lars Avemarie shared a definition yesterday of ones’ ‘Sense of Agency’, which refers to the feeling of generating and controlling actions in order to influence events in the outside world. Agency, as it’s often shortened to, lies close to ‘Self-efficacy’; confidence in one’s own ability to achieve intended results, a link between knowledge, skills and performance.
As an inpatient in hospital, I am invariably a passive recipient of treatment and medical care. I am a patient who has relinquished much if not all of my control to the medical team. I have no agency from a hospital bed and self-efficacy has a different meaning after discharge from inpatient care.

Being a “patient” in a medical setting is typically a disempowering process, albeit often temporarily so.

Describing myself as a patient feels disempowering. Describing someone else as “my patient” feels like I have created a power imbalance that I feel very uncomfortable with. People seeking my help need to feel empowered, not disempowered! I don’t feel it’s my responsibility to ‘fix’ people either; they do that. I spoke about that in my last blog here and Dr Silvernail (DPT) discussed the limit of our role in helping people get better on the Therapy Insiders podcast here.

If the value and skill in our role as a medical provider is to empower people, to build their sense of agency and self-efficacy and to avoid them becoming reliant upon us or passive treatments, then why do we use such a disempowering label as ‘patient’?!

I passionately dislike it!

In last weeks’ episode of Pain Reframed here, Physiotherapist Dr Roger Kerry (PhD) avoids like the plague referring to people as patients, and I don’t believe he used ‘clients’ either. I don’t believe it was a coincidence.

An Intensive Care Unit (ICU) is at one end of a spectrum of medical care where patients are entirely reliant upon the medical team. What do patients in an ICU value most? It’s not what’s directed to the psychopathological problems, it’s other variables like empathy, dignity and warranty which address the psychosocial issues that become closely interlinked with physical disease such as fear, anxiety and distress. “Humanization, defined as retrieval of respect for human life, considering the social, ethical, educational, psychic and emotional circumstances existing in all relationships, must be part of the physiotherapy philosophy. The physical environment, material and technological resources are important, however not more significant than the human essence. Indeed the latter must steer the actions of the physiotherapy team, enabling it to build up a more human reality, less aggressive and hostile for those experiencing a stay in the ICU.” Ref.

If humanization is so important at that end of the medical spectrum, why does it appear to be so different at the other end of the spectrum in private practice where biomechanics and tissues rule?

We need to spend a lot more time telling people what’s right with them and encouraging positive behaviours to improve their health, rather than focusing on and telling people what’s wrong with them, what they can’t do, or shouldn’t do, and what we can do to supposedly fix them.

On one side of the chasm there’s talk of weakness, tightness, instability, poor posture, malalignment, trigger points, things not firing properly, things being out of place, tissues sending pain messages and a host of other topics, all of which have negative connotations. ‘Patients’ are being disempowered by the language underpinning the postural, structural biomechanical model (PSB), much of which is simply a nocebo.

On the other side of the chasm, the language is positive. It’s what’s right with people, it’s what they can do, it’s encouraging and supportive, it’s empowering.

If we stop using the horribly disempowering ‘patient’ label, does it need to be replaced? I don’t think so.

 

 

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