Nothing About Me – Without Me !
By Dr. Zakiuddin Ahmed
The concept of empowered patient or ePT is the crux of the Patient Centric Healthcare Model, where the patients now expect – ‘Nothing about me-without me’.
It is imperative that physicians not only understand this concept but also become value added partners in this participatory medicine model to ensure success of the Patient Centric Healthcare movement.
Patient empowerment or ePt phenomenon emerged at the cross roads of the rising challenges in healthcare versus the opportunity of technology as a solution.
Healthcare challenges include increase in chronic disease burden particularly metabolic syndrome, deteriorating lifestyle, ethical breaches, increased life expectancy, poor eating habits, increased stress and microbial drug resistance, which have all contributed to negatively affect the safety and quality of healthcare.
Alternatively, techno-logical opportunities include increased access to information through web sites, mobile revolution, eHealth solutions, enhanced connectivity, social media, etc.
There are many ways ePt can be defined but the following provide a very comprehensive description: “A process that helps patients gain control over their lives, increasing their capacity to act on issues that they themselves define as important; a process through which patients individually and collectively are able to express their needs, present their concerns, devise strategies for involvement in decision making, and taking action to meet those needs”.European Union Network on Patient Safety and Quality of Care, PaSQ in 2012
Participatory Medicine is a model of cooperative health care that seeks to achieve active involvement by patients, professionals, caregivers, and others across the continuum of care on all issues related to an individual’s health. Participatory medicine is an ethical approach to care that also holds promise to improve outcomes, reduce medical errors, increase patient satisfaction and improve the cost of care http://www.jopm.org/
Simply put, patient empowerment is a process designed to facilitate self-directed behavior change. Glasgow and Anderson in the 90s proposed the concept of patient centered empowered approach in response to the then debated compliance and adherence concepts in managing chronic diabetic patients. http://care.diabetesjournals.org/content/22/12/2090.long
The famous “Macy Model of Doctor – Patient Communication” provided guidelines, as early as 1999, for patient education and shared decision making.
An empowered patient (ePt) therefore is
- Involved in the decision making process; ‘nothing about me without me’
- More informed about his/her medical condition & illness
- Owns and is responsible for his/her own health and plays an active role in its management
- Willing to adopt wellness as well as promote it among community of patients with similar needs
ePt is more equipped, enabled, engaged, expert, empowered, eHealth & digital savvy, ethical, equitable, educated & emancipated.
The benefits of the patient centric model are supported from research which shows that Empowering patients helps in
- Providing patients a realistic view of their medical condition
- Improving and developing trust and partnership between different stakeholders of the healthcare system
- Quicker response rates and recovery from treatment among patients
- Improving compliance by making patients responsible
- Reducing burden on the health worker by providing the patient the right to choose
- Creating a balance in the provider patient relationship towards shared common goals
- Improving health provider’s quality of professional conduct, ethics, quality and accountability
A systemic review of the evidence on four types of engagement strategies – health literacy, shared clinical decision making, self care, self management,& patient safety strategies found that all four strategies improved patients’ knowledge &experiences, reduced healthcare utilization &costs, and improved health status & behavior (BMJ.335, July 7,2007: 24-27).
The same were found to reduce healthcare utilization costs and improve health status
and behavior among patients. Physicians should make an effort to encourage the patients in their journey of empowerment by:
- Promoting responsibility among patients through guided access to information
- Referring patients to trusted health information resources
- Working closely with patients to develop a personalized health management plan
In the wake of current shift from acute & reactive care to preventive medicine & wellness, tertiary care centers to patient centered medical homes, and rapidly developing technology,
we need to proactively embrace the changes occurring in healthcare
for creating a more efficient and effective healthcare system.
With the rapidly deteriorating health of our people, creating communities of empowered patients is the need of the hour and doctors hold the key in successfully developing the patient centric healthcare models.
Mayo Clinic’s decision to invite a Patient as a visiting professor is a major leap towards recognizing empowered patients and their role in improving healthcare.
Let us take similar actions in developing a patient centric healthcare model for Pakistan as well. •
zakiuddinahmed@gmail.com