Ethics Principle 2D

Code of Ethics: 2D. Physical therapists shall collaborate with patients/clients to empower them in decisions about their health care.

Empower: To give power or authority to; to enable or permit.

It comes down to this quite often. A patient tells me that they will need [Surgery, Meds, Injections] because a medical authority told them they need [Surgery, Meds, Injections]. Caveat: this is true sometimes, in my opinion.

Once this phrase is uttered by a patient an immediate response is made that includes describing patient rights.

The fact that they are an adult, that they can make decisions on their own and that they are part of the discussion, not just the subject of the discussion. This is a foreign conversation and I often get the paternalistic statements rephrased back at me.  Now I restate my position. That they can say: yes or no or I-want-more-information at any time in all health care interactions. It is a conversation that they should be a large part in.

Thus far it seems (recall bias) that many are not aware that they have a say in the progress of their life in health care. I remind them that they don’t have to do any of the exercises I am instructing them on. They don’t have to come in to see me. They don’t have to take their medications or to go see a surgeon. They, of course, can decide to do all of these things, come see me, do exercises and take meds then have surgery.  I spend a lot of time trying to make my requests meaningful for them, so I hope they say yes.  At this point I’ll often get a “no, no, I’ll do it, it’s probably good for me.” I’m not sure that’s what I’m looking for, but that’s what I get.

How do you remind people that they are in charge? I love the emerging empowerment in helping someone see how they can effect change in their pain or their ROM, etc.  But when I attempt to empower them globally, in all health care decisions… well perhaps there is not clear feedback from that. They don’t see a change, positive or negative, when they take more or less responsibility in the conversation.

Knowledge is power. Patient education is our biggest asset and the lack of it is the biggest flaw in other aspects of medicine today. Explaining pathology, prognosis and plan of care is essential… but giving the authority to the patient, that is on a whole different plane. Not only must patients increase their knowledge of their current status and possible outcomes, but they must clearly be given authority to direct a course of action. Simple not easy.  I don’t blame this on anyone. When I talk with my financial adviser, well that’s outside of my wheelhouse, I wouldn’t feel as if I had a valid opinion in the area, so I can see how cloudy and unclear the medical world can seem to patients. But it is his job to help me understand. In both cases it is the same. A person is the end result, and their choices need to involve their own as-educated-as-possible decision on the matter.

We may be the experts in movement and physical therapies, but the patient is an expert in themselves. The power hierarchy can sometimes fail the system.  As Simon Sinek says, the people on the frontlines ” have all the information and none of the authority. The opportunity is to push the authority down.”

It’s more fun to treat an educated population, so educate them. It’s more fun to treat an empowered population, so empower them.

–Matt D