Enablement
The process of enablement involves enhancing your feelings of confidence and trust in your ability to remain in control. Clearly benefits can be derived from spending longer than 10 minutes working through the many issues that can arise. A pragmatic approach to problem-solving based on logical thought processes can help you feel more confident in the decision-making process. Often your "gut instinct" leads you in one direction and it is reassuring to validate that it is not misleading you. This process will build your ability to deal with issues in the future. Enablement can help balance the heavy weights and burdens that ill-health can bring.
Shared Decision Making
There is currently discussion between academics, medical professionals and health service administrators with regard to the level of involvement patients should have in making choices about the management of their illness. There is a perception that such collaborative working is not cost-effective due to a greater short-term investment and less ability to retain control over patient pathways. However many recognise the longer-term benefits and there is a movement being termed "Shared decision making" that is gaining in momentum.
In December 2010, 58 people from 18 countries attended a Salzburg Global Seminar to consider the role patients can and should play in healthcare decisions; this resulted in the Salzburg statement on shared decision making to guide clinicians and patients in the process.
This statement concluded:
"Many patients and their families find it difficult to take an active part in healthcare decisions. Some lack the confidence to question health professionals. Many have only a limited understanding about health and its determinants and do not know where to find information that is clear, trustworthy, and easy to understand."
It is widely accepted that there is a need to respect a persons autonomy and to gain their involvement and consent in treatment. It is quite clear from the above statement that something more than this is desirable. Great benefit can come from building autonomy through greater understanding; this goes beyond merely respecting autonomy. Information has become very readily available and its benefit can be further enhanced by a health consultant or information tutor to help you navigate your way.
Examples:
Clarify agenda and expectations
Review and discuss sources of information
Consider and communicate the issues of risk, probability and levels of certainty
Help formulate list of information required to aid decision making
Independent Fresh Insights
Considering all factors can make medical decision-making more complex and time-consuming; there is an attraction in handing-over responsibility entirely to the medical team. Whilst superficially this may appear a simpler approach, the resulting disempowerment can be a barrier to health gain. This often manifests as a diminished engagement in health promoting activity and a lack of concordance with treatment plans. Such avoidance is totally understandable human nature, so lets not get mired in earnest disapproval; the health consultant is broad-minded enough to be accepting of such a nihilistic viewpoint. Here's a light-hearted quote:
"For every complex problem there is an answer that is clear, simple, and wrong."
H. L. Mencken
Whatever your viewpoint may be, there will be benefit in gaining individualised, independent fresh insights to strengthen your engagement, broaden your horizons and consider new avenues to enhancing your health; if that's what you want. In most cases progress can be made by viewing the situation from a new angle; a restorative process brings balance and allows problems to diminish. The health consultant is considerate in not adding further burdens, is flexible and able to adapt to your agenda.
