Empowerment Failure: How Shortcomings in Physician Communication Unwittingly Undermine Patient Autonomy

Abstract

Many health care decisions depend not only upon medical facts, but also on value judgments—patient goals and preferences. Until recent decades, patients relied on doctors to tell them what to do. Then ethicists and others convinced clinicians to adopt a paradigm shift in medical practice, to recognize patient autonomy, by orienting decision making toward the unique goals of individual patients. Unfortunately, current medical practice often falls short of empowering patients. In this article, we reflect on whether the current state of medical decision making effectively promotes patients' health care goals. We base our reflections, in part, on research in which we observed physicians making earnest efforts to partner with patients in making treatment decisions, but still struggling to empower patients—failing to communicate clearly to patients about decision-relevant information, overwhelming patients with irrelevant information, overlooking when patients' emotions made it hard to engage in choices, and making recommendations before discussing patients' goals.

Keywords:

• autonomy
• informed consent
• physician/patient communication
• shared decision making

This article is referred to by:

Medical Culture's Bias to Actively Intervene Can Undermine Patient Empowerment and Welfare

Sowing the SEED for Patient Empowerment

Informed Consent Is Inadequate and Shared Decision Making Is Ineffective: Arguing for the Primacy of Authenticity in Decision-Making Paradigms

Autonomy, Information, and Paternalism in Clinical Communication

Health Communication: Not Just Autonomy, Also Justice

Needed: A More Rigorous Analysis of Models of Decision Making and a Richer Account of Respect for Autonomy

Communication Education, Modeling, and Protocols Transform Clinicians to Agents of Empowerment

FUNDING

Financial support for this study was provided in part by the following institutions: an IIR Merit Award from U.S. Department of Veterans Affairs (IIR 05–283) to Angela Fagerlin, a Health Policy Investigator Award from the Robert Wood Johnson foundation to Peter A. Ubel, and Federal Grant T32 GM007171 to Karen A. Scherr as part of the Medical Scientist Training Program.