The traditional roles of doctor and patient, and the balance of power between the two, have been shifting in recent decades. In the past, doctors were seen as patriarchal authority figures who should be looked up to, listened to, and obeyed with very little questioning. Even when patients did not understand what their doctor was saying or fully comprehend their condition, they were expected to comply with instructions and treatments that were prescribed. As thought shifted in places of employment and other social structures with the realization that people, as a whole, cared more about the success of anything they felt a stake of ownership in, so too did these thoughts start to shift in health care. Several studies have now shown that patients who feel empowered and in control of their own health care experience better health outcomes and greater satisfaction with their providers and the system as a whole. Few studies, however, have attempted to discover whether or not patients are feeling more empowered in their own health care today. Fewer still have attempted to break down any social groups to see if disparities exist from one to another. Therefore, a survey was conducted among both members of the Denver black community and the Denver healthcare community to see where each stands on issues of patient empowerment and if there are disparities between the two.
Patient empowerment is a difficult concept to define, and scientists from many fields have struggled to find a common definition. As an overall concept, we felt that empowerment should be viewed as several components, and so we developed an eight question survey to get a feel for where the community stands on several topics important to empowerment. Patients were asked to rate, on a 0 to 10 scale, how much they agreed with the following eight statements:
- I feel empowered in the process of my health care.
- My health care providers listen to my needs and concerns carefully.
- I always have a clear and efficient pathway to address concerns with my care.
- I am comfortable asking questions to my health care providers.
- My health care providers take my questions and concerns very seriously.
- I always have the final say in decisions about my health care.
- My health care providers have time to listen to and address my questions and concerns.
- I would feel comfortable asking for a second opinion if I have concerns regarding my health care.
Patient advocacy personnel from several area hospitals and clinics were asked a series of similar questions with slightly different wording in order to get a feel for how they feel providers in the Denver area are doing with regards to patient empowerment.
On a whole, patients actually rated empowerment higher than healthcare personnel. This was a surprising result, but is good news for a couple of reasons. First, and most obvious, it seems that healthcare providers in the Denver area are doing a good job making sure patients feel empowered in regard to their own health care. Second, perhaps less obvious but even more important, healthcare personnel, specifically patient advocacy personnel, still see room for improvement. If patients are already satisfied in a system that is still working to improve itself, then chances are good that satisfaction will continue or improve in the years to come.
Breaking down ideas more individually, patients felt strongly that they are listened to and that their concerns are taken seriously. The vast majority felt that they definitely have the final say when it comes to decisions regarding their healthcare. This is important, as patients are less likely to even seek medical care if they feel that they will not be listened to or that their decisions and desires will be ignored. Where patients see the most room for improvement is an area that has long been a struggle in the healthcare community: time. The lowest ratings were for providers taking enough time and really listening to them. Patients feel listened to when they have time to make their point, but feel that providers still do not always have the time to listen adequately and address concerns. A few commented after completing the survey that they would feel even more comfortable if their doctor did not seem like they needed to get to the next room so quickly. Sometimes, the time allotted for patient contact is governed by insurance, or by the larger healthcare organization that a provider works for, so perhaps these are good places to start, or continue, addressing these concerns.
While these concerns exist, and are real, advocacy personnel seem to be aware of them and are no doubt working behind the scenes to correct these areas. It is, after all, their job to make sure patients are heard, listened to, and feel empowered in their own care. Overall though, for the Denver black community, the news seems to be good with regard to patient empowerment. Patients feel like they are ultimately in charge of their own care, and as studies have shown, this is likely to lead to better outcomes than the patriarchal systems of the past.
By: Christopher Williams, University of Denver Student