The scientific case for patient empowerment

Most of us operate in the belief that patient empowerment is a good and necessary thing. Indeed, much of the volunteer work we do in arthritis is predicated on that assumption. We feel good when we’re in control.

But is patient empowerment and control actually good for us in the therapeutic sense? Do we make better progress in staying healthy or recovering from surgery or illness if we have a sense of empowerment? Is there any objective scientific evidence to support that belief?

The answer seems to be “yes”. I recently read a wonderful book on a psychological theme, which I want to recommend to you for summer reading. It is not a heavy tome or one laden with numbing medical / psychological jargon. In fact it’s brilliantly written and very accessible. It is titled “Stumbling on Happiness” and the author is renowned Harvard psychologist, Dr. Daniel Gilbert. You can readily find a nice, lightweight and inexpensive paperback copy of this book at most bookstores to slip into your beach bag for your summer reading. On top of everything else, it’s also very funny---a definite plus for a book that addresses the subject of psychology, something which usually strikes me as being about as diverting as an expose on double-entry bookkeeping or perhaps, “Accounting for Dummies”.

Gilbert begins his book by asking the question: “What primarily differentiates human beings from the rest of the animal world?” Opposable thumbs? Upright bipedal posture? Big brains? All of the foregoing?

According to Gilbert, the human being is the only animal that thinks about the future. He says (and this will give you a sense of his style): “I’ve had cats, I’ve had gerbils, mice, goldfish, and crabs (no, not that kind) and I do recognize that nonhuman animals often act as though they have the capacity to think about the future. But as bald men with cheap hairpieces always seem to forget, acting as though you have something and actually having it are not the same thing, and anyone who looks closely can tell the difference.”

Gilbert asserts that homo sapiens made its most important evolutionary leap forward when we developed our enlarged temporal lobes and began imagining tomorrow or what he terms the process of “nexting”. And this development saw us also embrace a passion for control --- a passion, which, if thwarted, makes our species become unhappy, helpless, depressed, hopeless, and sometimes dead.

Gilbert observes: “Our desire for control is so powerful, and the feeling of being in control so rewarding, that people often act as though they can control the uncontrollable. For instance, people bet more money on games of chance when their opponents seem more incompetent than competent – as though they could control the random drawing of cards from the deck and take advantage of a weak opponent. People feel more certain they can win the lottery if they can control the number on the ticket control”.

Among much other evidence in his book on the impact of being in control, Gilbert cites the following study:

“….researchers gave elderly residents of a local nursing home a houseplant. They told half the residents that they were in control of the plant’s care and feeding (high-control group) and told the remaining residents that a staff person would take responsibility for the plant’s well-being (low control group). Six months later, 30 % of the residents in the low-control group had died, compared with only 15 % of the residents in the high-control group. A follow-up study confirmed the importance of perceived control for the welfare of the nursing home residents….. Researchers arranged for student volunteers to pay regular visits to nursing home residents. Residents in the high-control group were allowed to control the timing and duration of the student’s visit and residents in the low-control group were not. After two months, residents in the high-control group were happier, healthier, more active and taking fewer medications than those in the low-control group.”

What I found particularly interesting about the above study is an unfortunate (and quite unanticipated) downstream consequence. And that surprising consequence contains a valuable lesson for all of us who seek to advance patient empowerment within the Canadian medical care system.

After the student visits to the elderly residents had been discontinued, a disproportionate number of residents in the high-control group died. What was the cause of this tragedy? Those who had been given a high degree of control were inadvertently robbed of control when the study was terminated. And that same loss of control was empirically injurious, injurious to the point of being fatal. Advocates and health care professionals take note: Gaining and having control can have a decided and measurably favourable impact on health and well-being, but losing control can be worse than never having had any at all. We all need to keep that finding in mind when we are advocating patient empowerment. It seems that once the path to empowerment has been blazed, turning back to less assertive models can actually do you in.

So let’s all ‘stay in control’ and have some happy summer reading, too!