|
The Psychosomatic Letter
December, 1997
The
Uneducated Patient
At
best, chronic and refractory physical diseases and injuries represent
a challenge to the patient, requiring that he/she determine a future
direction, a means of dealing with the residual symptoms, derive
meaning from a compromised life, and have the capacity to understand
what has occurred.
Health
care was designed around a dependency system in which patients rarely
participated in preventive health practices and minimally participated
in the recovery process. The concept of prescriptive treatment is
based upon the patient maintaining a passive role in which a clinician
determines what treatment is indicated and how that treatment should
be implemented. Patients do not choose which diagnostic studies are
indicated. Patients do not choose their interventions, whether they be
drug and/or physical therapies. And patients who express strong
reservation regarding what they feel is indicated in their treatment
are seen as resistant, hostile, passive-aggressive, drug-seeking or
simply noncompliant.
Many,
if not most, clinicians attempt to educate the patient as to the
nature of their problem, the treatment indicated, the risk/benefit
ratio of that care, the timeframe in which treatment will occur and
the probable outcome. Just as often, however, three problems emerge:
-
the
clinician’s time allotment for the appointment does not permit
in-depth patient education,
-
the
patient is overwhelmed by the complexity of the problem, the
information presented and the task of incorporating new data while
anxious regarding the findings thus far explained,
-
or
the patient is seen (perhaps correctly) as being unable to fully
understand the problem.
Under-educated
patients, therefore, emerge from two sources which are not mutually
exclusive. The patient may, in fact, have little formal education.
Written materials and verbal explanation by health care extenders are
not readily incorporated. Such explanations make demand upon the
patient’s capacity to incorporate the terminology and treatment
options into a cohesive whole, and from this "understanding"
to provide truly informed consent.
The
patient told of the assessment of his/her chief complaint, and having
been provided with explanation as to the cause, care and prognosis
may, in fact, be an uninformed patient in that there is no
intellectual or educational basis upon which the patient can form a
functional understanding of the situation. Compliance with care then
becomes a recurrent pattern of dependent consent in which the patient
remains bewildered or confused if not frightened.
The
consequences of treating the under-educated patient are multifold:
1.
Due to disappointment in outcome of treatment to date, the patient
either increases expectancies from subsequent care or begins to
withdraw, perceiving that care has little to offer and has become
associated with both pain and futility.
2. The patient is no longer able to separate their own role from that
of the health care providers, what they should expect of themselves as
well as others and how to best communicate those expectancies
throughout the course of care.
3. Patient develops a pattern of either passive-compliance,
passive-resistance or passive-aggression in which, inability to
verbally express their confusions and concerns in an effective and
problem-resolving fashion. has led to a series of self-defeating
behaviors, in which they are now participants in the cause of the
problems they are experiencing.
The
informed clinician, and that whom the patient is most likely to see as
effective, is one that is able to communicate to the patient the
combination of respect for what the patient knows, can be taught, and
needs to know, in order to effectively facilitate whatever degree of
recovery is to occur. This may require asking that the patient express
his/her understanding of the assessment (problems) and plan of care.
During the course of that explanation, the clinician can both add and
clarify data.
Unless
the under-educated patient feels that his/her role is that of
facilitating care, probability of recovery may largely reside in
chance.
|
