Mind Your Language #3

The ways in which the word "empowerment" is used is of continual interest to me. These were my thoughts in connection with people with diabetes and their relationships with Health Care Professionals.

First Published in Update circa 2004.

Is ‘patient empowerment’ really ours to give, asks Andy Usher

“Can I have grapes?”

“Well there’s a bit more to a diet than that.  You won’t need to ban certain foods you will have choices within the principles of healthy eating.”

“So I can have grapes?”

“Within reason, if you have too many at a time it might put up your blood glucose…”

“No grapes then.”

“Forget the grapes for a moment.  What you’ll need is to take on board the information that will enhance your personal control over the day-to-day management of your diabetes in a way that enables you to experience the best possible quality of life.  Do you see?”

“OK. What about bananas?”

Perhaps it would be more fruitful (excuse the pun) to hand the patient a diet sheet. One list of ‘good’ foods and a longer list of ‘no-no’s’.  But once you’ve handed it to them you’ve made up your mind for them – no awkward choices to manage and no grey areas – do this and you will be okay; don’t and you won’t.

Quite a lot of power to manage isn’t it?  Or is it? Given the number of patients who do not ‘comply’ with the sensible recommendations they’ve been given, let alone the treatments, what power do we actually have as health care professionals?  Patients nod and do what they want anyway. They are wilful. Perhaps we are getting closer to the point – patients are wilful because they have their own will and they exercise their will even when we know better and their choices are wrong. Would we do any better? Healthy living is recommended for everyone, so ask yourself if your daily routine is identical to the one you propose to your patients.

This is where my concern with the term “Empowerment” comes from. Originally the term was a legal one – to give legal authority to someone who did not have it. It means that when we talk about empowering the patient it presupposes that when they come to us they entirely powerless. The concept is based on an assumption that the patient is lacking at the outset, lacking resources, capacity, knowledge or any other tool of value until we deign, from our expert position, to empower them.

It is tempting to believe we have the answers our patients dearly wish we could give them, especially when vulnerable. But it’s a belief that potentially disarms, disempowers and disenfranchises the patient from their own resources – the capacity to learn about their condition and make decisions for themselves, whether we agree with them or not.

The challenge is not to empower patients but to develop consultation styles, language, health settings and environments and restrain our own impatientce and frustration in ways that do not so readily disempower patients of their resourcefulness.