Oasis Wellness Empowerment Series #3: On the Journey towards Patient and Provider Empowerment

In the first segment of this series, we discussed how the Internet can serve to empower both patients and providers in our somewhat maddening health care system, while in the second segment, we exposed some of the uglier sides of that system and how they interfere with healing. Today, we give concrete steps for both patients and providers to become more empowered and briefly examine how a new role in nursing, the Clinical Nurse Leader, is poised to play a principal role in cleaning up the mess in which we find ourselves.

---

As we all know, our health care system is in trouble.

Patients are unhappy because they don’t really understand why they’re paying so much money as consumers into a system that gives them little choice but to manage disease with medications, which act to suppress and often cause more damage to one’s health in the process. Many patients would rather prevent illness or heal from it using alternative treatments, but they have to pay out-of-pocket and/or get flack from uninformed practitioners. Thus, patients feel powerless.

Providers are unhappy because they know the system is in trouble, and they know that patients are unhappy, but they don’t know what to do about it. Health care is a huge, for-profit industry, mainly for insurance and pharmaceutical companies. Thus, providers feel powerless, too.

Are you seeing a running theme here?

In the second segment of this series, I introduced a new model of care called the “Collaborative Empowerment Model,” whereby both patient and provider create a healing model through collaboration and empowerment. I promise that I will devote an entire future article to how this model works, but for the time being, I think it’s more important to give you all concrete steps to become more empowered. We are in a crisis situation, people.

In addition, I’m excited to introduce many of you to a new role in nursing called the Clinical Nurse Leader.

But first, the steps.

Let’s start with patients – consumers. After all, you’re the reason we’re all here.

It’s not easy being an empowered patient in our current health care system, which places way too much emphasis on “the doctor/pharmaceutical company/FDA is always right”, and too little emphasis on what might actually work best for that patient.

I’m going to let you in on a secret. There’s ONE step that you have to take to become empowered. Just ONE. Ready?

Ask questions.

That’s it. Of course, it comes with a few caveats.

First of all, don’t stop asking questions until you are satisfied with the answers you’ve gotten. Be relentless. It’s possible that your health care provider will become uncomfortable when you ask these questions, because they may not have the answers. That’s ok. This is your health at stake, and you deserve the answers, not to mention the fact that you – either out-of-pocket or through sky-high insurance premiums and deductibles and co-pays – are footing the bill. You hired the provider, not the other way around. 

Here are some possible questions you can ask your provider when they diagnose you with a health condition and then prescribe something, and you feel unsure about it or would simply like more information to make an empowered decision. (Information = power!)

1. What are the side effects of this medication/treatment?
2. How long do I need to be on it?
3. What does the current research say about this medication/treatment as well as alternative treatments/options? Are there any studies comparing this treatment with no treatment at all?
4. Is there anything else I can do that would help me overcome this health issue, such as diet and lifestyle modifications? What about acupuncture or herbs?
5. Would you take this medication or undergo this treatment if it were you or a loved one dealing with this health issue?

If you continue to find that your provider is not amenable to your empowerment, seek out a registered nurse. The cornerstones of a nurse’s legal scope of practice include patient education and advocacy, and our principal ethical obligation is to advocate for a patient’s independence, even if we ourselves don’t agree with the decision the patient wants to make for him/herself. A registered nurse should always have your back. (Unfortunately, as many of us have experienced, some nurses have forgotten this.)

Now, providers… Remember how I said that the current research-practice gap is a whopping 17 years?! This is our chance to close that gap. (Information = power!)

At the very least, we should search the published literature:

• To stay current on evidence-based practices;
• Whenever a patient comes in with a condition we’ve never treated or don’t feel confident treating;
• Whenever the patient asks us for information that we can’t provide;
• Whenever a patient experiences adverse effects from a medication or treatment and/or requests a different treatment.

I know that some of you think I’m crazy to suggest this. You are already overworked with 5-minute primary care visits, hourly rounding, chart audits, and high patient ratios. However, don’t underestimate the powerfully positive effect you can have on a patient when you give them the information that they deserve to make an empowered health care decision.

Besides, this is where the Clinical Nurse Leader comes in handy.

The CNL (not CNS) is a new master’s prepared role in nursing that was designed in part for this very aspect of our health care crisis. The CNL role combines research, practice, education, and advocacy, and as a generalist can focus wherever there is greatest need. To give you an idea of the importance of the CNL role, the Veterans Administration would like to have a CNL on every unit in every VA hospital by 2016. (That’s probably not going to happen, but it’s a worthy objective.)

If you’re a patient, the CNL can help you to navigate the specific part of the health care maze where you might feel lost, whether that’s in a clinic, hospital unit, or long-term care facility. This includes when you want to incorporate complementary or alternative treatments into your care but are facing resistance from another provider. If your facility, unit or clinic does not employ a CNL, ask them why not!

For practitioners, the CNL is there to troubleshoot and solve consistent problems in your area of care, whether that’s keeping up-to-date on evidence-based practices, preventing medication errors, dealing with a cranky manager, or coming up with a more efficient scheduling system. Difficulties in any of these areas can prevent providers from feeling empowered, and that has a direct impact on patient care.

If anyone is poised to empower, it’s the CNL.

Patients and providers, we can come together to create top notch, cutting edge, evidence-based care. It might mean having uncomfortable conversations, or admitting when we don’t know something, but we can start to change the system right here, right now for the better simply by taking these easy steps towards empowerment. And if you feel like you just can’t go it alone, find a CNL to act as your advocate and guide.

 Together, we can do this. Let’s make it happen. I’m ready.