More Dialog on "Patient as Doctor"

I wanted to let you know how I chose to use your essay, "Patient As Doctor," in my class. Some background: ...I teach a Professional Foundations of Nursing course to 96 junior nursing students (so they are early in their nursing education and have a varied range of patient care experience). In this course they learn about nursing history, ethics, laws relevant to nursing, the image of nursing, the US health care system and leadership.

In class yesterday, students divided up into 16 groups of 6 students and followed this format:

In your assigned group, designate the following roles:

    1 writer
    1 timekeeper
    1 presenter

Read the essay below and answer the following questions. Be prepared to share at least one of your group's responses with the class.

Patient As Doctor

1. How does this patient's account make you feel?

2. In your opinion, does the US health care system disempower patients?

3. If so, what examples have you seen?

4. What can nurses do to promote patient empowerment within the US health care system?

After their group work, each group had one presenter come up to the front of the room and answer the questions listed above. Students had some powerful responses.

Students felt saddened, uncomfortable, surprised, not surprised and ashamed by your account. They believed that the health care system does disempower patients and some of their examples included: doing to the patient before asking or obtaining consent, not explaining rationale/educating, not providing the patient with options or choices, not encouraging the patient to ask questions, rushing through patient care, and not using an interpreter. They felt that some subgroups are even more likely to be paternalized/disempowered, including the elderly, the disabled, those who do not speak English, and the mentally ill. They provided several inspiring examples of how nurses can promote patient empowerment, giving me hope for the future of nursing and the advocacy of nursing as a counterbalance to the predominant medical model of care.

Just wanted to share and extend my appreciation of your willingness to let me use your writing in my teaching. I think that is was a very powerful exercise for the students!

Best,

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Interesting and valuable feedback.  I’d like to add one more comment in response to this one that someone submitted:

Your article makes a number of good points about our paternalistic system. Whether it is medicine, law enforcement or the media we are treated as if we can NOT make informed decisions on our own.

 Again, it’s also about personal responsibility.  We are treated the way we allow people to treat us.  We have to step up to the plate and choose:  accept what we’re told, question what we’re told and then decide, or reject what we’re told.  Even these choices are our decision, so to say we’re treated as if we can NOT make informed decisions is a cop-out.  The system won’t change just because we blame it.  We have to change the way we respond to it.

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My response:

I agree that we need to affirm and nurture personal responsibility. But why should the patient always have to fight to be heard? Why don't the professionals initiate dialog? Patients are often already stressed out. Fighting or pushing adds to the stress.

I do not believe that I blamed the professionals. As I see it, individual patients are a component of the System. Blame is shared.

It's not either/or. We need not blame the individual either. But often others treat us the way they choose to treat us -- not because we allow them to do so.

In my case, I did resist quite a bit. But when you've got a 103-degree fever and are wiped out by multiple drugs, it's hard to speak up consistently.