On my soapbox again: Health care providers do not empower patients

I’m on my soapbox again: Health care providers do not empower patients.

Yes, I’m picking at semantics. But words influence thoughts, and thoughts create actions. If we don’t look at our words, it could lead us down the path of ineffective action.

The dictionary has 3 definitions of empower:

1. give (someone) the authority or power to do something, as in “nobody was empowered to sign checks on her behalf.”

Well, that one doesn’t apply to health care. We don’t give them power or authority. Patients already have the right and authority to manage their own health.

2. enable (someone) to do (something)

This doesn’t apply to health care either. They are either able (capable) or not able (incapable). They may not have the skills, or the knowledge, or the motivation. But we don’t give them ability.

3. make (someone) stronger and more confident, especially in controlling their life and claiming their rights

Ah, this is the one you’re talking about. But when you use the word empower in this context, it doesn’t really describe the next step. You might be fooled into thinking it’s just a transfer of power. This could result in the health care provider giving up (“The ball is in your court, patient. There’s nothing more I can do.”) rather than taking action to improve health outcomes.

No, when you use the word empower you’re really talking about self-efficacy. Self-efficacy is the level of perceived confidence and comfort in completing a specific task. It is the belief, “I can do that.” Self-efficacy is measurable (“on a scale of one to ten, how confident are you that you can . . .”).

There are defined interventions to improve self-efficacy: Self-efficacy can be enhanced through skills mastery, modeling, reinterpreting the meaning of symptoms, and persuasion. (Lorig, 1996)

So catch yourself the next time you find yourself talking about empowering a patient. Substitute self-efficacy for empowerment. Then think about what you just said.

Changing that one word should give you a better idea about what to do. Help the patient master a skill. Introduce the patient to another, similar patient who succeeded. Help the patient see the symptoms from another point of view, one that supports success. Find out what the patient is having trouble with, and apply health coaching to address it.

Jane Vella (2002) said it best:
“Teachers do not empower adult learners; they encourage the use of the power that learners were born with.”

So go forth and take steps to encourage that increase in self-efficacy!

Resources:


Lorig, K. R. (1996). Patient Education and Counseling for Prevention. from http://odphp.osophs.dhhs.gov/pubs/GUIDECPS/text/iv_edu.txt


Vella, J. (2002). Learning to listen, learning to teach: The power of dialogue in educating adults (Revised ed.). New York: Jossey-Bass. page 10

©(2011) Fran London, MS, RN