Are patients taking over the professional roles of healthcare practitioners? More healthcare related information available online means more patient empowerment. How does this development affect the doctor-patient relationship?
A fundamental tenet of healthcare is that every patient is unique. And that means a particular disease can have a totally different impact on different patients. Developments in science and technology mean we can personalize treatments more than ever. At the same time, patients and their families now have access to a mind-boggling amount of healthcare information.
This information gives patients the opportunity to take more control over their treatment. As they become increasingly knowledgeable, the entire doctor-patient relationship is changing. Patients want to be informed and consulted and they are becoming the real experts of their disease.
However, patient empowerment does pose some risks. Not every patient has the necessary skills and knowledge to weigh-up the information and data. And the Internet and other sources are polluted with information that might be inaccurate or is at best open to misinterpretation, but increased patient responsibility also offers some real win-win situations.
There are some amazing stories of patients doing just that and achieving fantastic outcomes. I came across a 30-year old man with a complex ankle fracture, for example. He had an operation to secure the bones but wound healing stagnated and it turned out he hadosteomyelitis. When it was diagnosed, we gave him aVivanoTec, a unit fornegative pressure wound therapy. Although negative pressure therapy is an advanced way of treating wounds, he needed to manage the treatment himself.
Assuming that responsibility meant he needed to understand how the therapy worked and how to manage the pump unit. However, it also meant he could go back to work and live his normal life by simply bringing the VivanoTec along in his backpack. Without the combination of the relevant technology and the patient’s willingness to take responsibility for his own treatment, healing would have taken much longer and he probably would have lost his job.
As responsibility shifts from clinician to patient, they become partners instead of patients simply following instructions. Patient empowerment also means responsibility for success or failure is shared. Physicians and nurses take the role of coach, while patients become the specialist for their unique disease.
What is the clinician’s new role?
Patient empowerment requires new skills in healthcare professionals. Instead of giving orders to patients, they have to assess the patient’s ability – often alongside the family’s – to follow the necessary treatment. They also need to teach patients to recognise the early signs of complication.
It could be dangerous if patient empowerment gets mixed up with basic patient information: just giving leaflets to the patient isn’t enough. The basis for successful empowerment has to be in-depth communication.
Interestingly, the empowerment of the patients also empowers nurses to become the trusted advisors. They are frequently the closest people to the patients and their families, and therefore in the best position to provide advice.
It is also important to educate patients so they can predict when they will need help; clinicians therefore need to become educators. For example, the link between age and incidence of skin conditions is well known. Information about the early recognition of metabolic and vascular disorders needs to be readily available, as does information about treatments. In this specific instance, part of the education is about removing the stigma.
I have learnt from Chinese wound care students about the culture of making the treatment of skin conditions a fun, encouraging and motivating experience for both patients and their families. Given continued education, we could reach the point when wearing wound dressings is as normal as wearing reading glasses.
The relationship between patients, and doctors and nurses is changing rapidly. While patients want to take more responsibility for their treatment, the ultimate responsibility remains with the highly-trained clinicians. It is therefore our job to react positively to this change, to exploit the altering relationship to ensure the quality of healthcare is enhanced.