Patient empowerment: its role in polypharmacy
Who holds the power in healthcare? On the face of it, the answer is simple. Healthcare professionals have expert knowledge of both diseases and treatments, and are de facto in a position of power and control. This was certainly true in the past. However, in the last 20 to 30 years, there has been a growing movement towards patient empowerment to improve patient safety and outcomes.
Understanding patient empowerment
There are many different definitions of patient empowerment. The World Health Organization defines it as “a process through which people gain greater control over decisions and actions affecting their health”, which may be either at individual or community level. For individual patient empowerment, studies have found that individual patients must understand their role, and have sufficient knowledge and skills to engage with healthcare providers. The environment must also be supportive to enable engagement and empowerment.
Empowerment is therefore not an easy state to achieve. It requires mutual respect between patient and provider for each other’s knowledge and expertise, and a willingness to listen and engage. Over the years, policy-makers have made efforts to push towards full patient empowerment on the grounds that this is safer and better for patients. For example, empowered patients are more likely to prevent medical errors, such as mistakes in surgery or medication administration. They are more likely to notice that something is wrong, and more likely to speak up when this happens. Patients are also the ones with the greatest knowledge about their own symptoms. People with long-term conditions in particular often develop expertise and knowledge of their disease and its treatment.
This has led to positive developments such as the trend towards patients as advocates for their own health, and the concept of patient-held records. This last is an idea that has been around for many years. It should surely be relatively easy to deliver in our ultra-connected world, but somehow this doesn’t seem to be the case. The real question for me is why has this not happened? What is preventing this kind of manifestation of patient empowerment from being the norm?
Appreciating the limitations
There are two sides to the patient empowerment situation: patients and healthcare professionals. Let’s start with patients. More empowerment is generally better for outcomes. However, some patients will inevitably want more control over their healthcare decisions than others. Some will also be better able to take control.
For example, older patients who are confused or forgetful may find it harder to understand all the necessary information to support their decision-making. Patients who are in a lot of pain are also probably not likely to be most engaged, because it is hard to think clearly under those circumstances.
Healthcare professionals too can be wary of giving patients what they see as ‘too much power’. The internet is a wonderful source of information, but not all of it is accurate. Celebrities raising awareness of particular conditions can also be a bit of a double-edged sword for healthcare practitioners. Patients (incorrectly) convinced that they have a particular condition because they heard a celebrity mention it, or they read about it via ‘Dr Google’ can be hard to persuade otherwise. Similarly, just because a celebrity was advocating a particular treatment does not make it right for everyone.
On the whole, empowerment is probably best seen as a process, and a continuum, not a static situation. Some patients may be better able to take control — and the same person may be more capable some days than others.
Patient empowerment and polypharmacy
How does this all fit with polypharmacy, where patients are taking multiple medications? These ideas have serious implications. There is no doubt that patients or family carers are best placed to see when medications are interacting, or when there are side effects to one or more drug. It is important that they feel able to speak up and discuss issues on equal terms with healthcare professionals, both prescribers and pharmacists.
However, many of the limitations discussed are particularly relevant for the groups most likely to be affected by polypharmacy. These include older people, psychiatric patients and people with conditions like cancer, who may be in a lot of pain. It is not always easy for these groups to feel in control of their health and healthcare.
My view is that the benefits of patient empowerment are significant in managing polypharmacy. The only question is how we can find a suitable way of empowering people to take control of their healthcare and medication given all the potential limitations.
