Patient autonomy has become a buzzword in our industry and it tends to be discussed like a philosophy, but rarely in terms of actual patient interaction. So, today I’d like to share some insights about patient autonomy and how you can approach it in your practice.
The Basis of Patient Autonomy
Of all the memories I have from studying to get my Advanced Practitioner Nursing degree, one that continues to stand out is when a professor told us that our primary job as nurses is to provide education. At first, it seemed like an odd thing for her to say since all of us students were spending a bunch of money and time studying everything about the human body we could possibly cram into our brains…and none of our classes focused on “educating” the patient.
But 12 years later of being both an APN and a nurse entrepreneur, I can tell you that not only was my professor right, but education is the cornerstone for facilitating patient autonomy within your practice.
International law requires providers to obtain informed consent from patients when it comes to:
- medications
- vaccinations
- procedures, surgeries
- imaging
- testing
This means it’s up to the provider to clearly communicate the risks and the rewards of each action. Our job is to educate and let the patient make up their own mind.
The Consequences of When Patients Don't Feel Heard by Providers
The medical profession is deeply rooted in a paternalistic approach, and one of the many lingering remnants is to infantilize patients. Historically, the medical profession has been held in an elevated light and doctors given a special, almost god-like status. Doctors would condescend to patients with a tone of “I know what’s best for you and your body, more than you do.”
And that approach can have some serious consequences.
When patients feel bullied, judged or shamed…
When patients don’t feel seen or heard…
When patients lose trust in their providers…
They get scared and find other – often more dangerous – paths.
One of the reasons our practice has grown so quickly is because our patients feel seen and heard. And they tell their friends. A central tenet of our practice is that we will not judge, shame, or fear-monger our patients. We explicitly state this on our website.
So, I hear all the things patients have done on their own when they don’t trust their provider. Most recently, I’m hearing patients who had COVID say things like:
“I got prednisone from a friend…”
“My neighbor gave me a few doses of leftover doxycylcine…”
“I went ahead and got the veterinary ivermectin….”
Wouldn’t it be better to have a conversation with patients and help them make decisions safely?!
I make it a point to let patients know that they never have to be embarrassed to share or ask anything. Because if they don’t, then they definitely aren’t getting the education they need to make informed decisions.
When Patient Autonomy Feels Personal
Embracing patient autonomy means having the core belief that each person is a sovereign being. Patients have the right to make their own choices for their own bodies.
Does that mean patients will sometimes make decisions you don’t agree with? Yep.
So long as you did your job in educating the patient along with documenting your conversation and their decision, then you’ve done your job.
Ignorance isn’t stupidity. Ignorance is a knowledge deficit. And when we educate patients, we can fill in those knowledge gaps.
When I was 27, my dad had signs of ischemic heart disease and despite my concerns, he didn’t want to go to the ER. He and my mother (a nurse) were in denial even though all the symptoms were clear (to me). A few months later, my dad was awake in the middle of the night with what had become routine left shoulder pain. My mom was massaging his shoulder when he lost consciousness and took one last gasp of air. She performed CPR and they worked on him for 2 hours in the ER to no avail. He died of a massive heart attack.
Flash forward to a few weeks ago when I’m talking with an elderly patient with COVID who is showing potential signs of stroke. I strongly recommended that he go to the ER and I told him my concerns. He didn’t want to go. I ultimately have to respect his decision because my patients don’t need my permission.
It was my dad’s right not to go to the ER, just as it’s my patient’s right. Unfortunately, that decision didn’t work out for my dad and my family. And fortunately, my team and I have been able to provide our patient with continuous care and knowledge so that he can continue to make his informed decisions about his body and his life.
Embracing patient autonomy isn’t always easy. Sometimes it can feel very personal.
How Patient Autonomy Makes You a Better Provider
Knowledge & Communication
When patient autonomy is a core belief for you and your practice, you don’t bully your patients into decisions (like many doctors have done in the past). Instead, you work your hardest to educate YOURSELF and improve your communication skills so that you can go home confidently knowing that you provided every bit of knowledge your patients needed in order to make informed decisions.
Time
Ethically embracing patient autonomy requires one very important element: time.
Sadly, many practices are not set up to give patients and providers the TIME they need to have a conversation.
Somehow the medical profession has evolved into an assembly line of 15-minute appointments.
Tell me, how can you possibly delve into the risks and rewards (and complexities) of medical decisions in just 15 minutes?!
We need more practices to offer longer appointment times. Within UltraPersonal Healthcare, we give patients the time they need. Sometimes that means 75-90 minutes. It’s freeing to have the time to actually talk and connect.
The topic of how to structure appointment times is too big to cover in this article, but just know that 15-minute appointments are shortchanging providers and patients.
I’ve seen the consequences resulting from providers bullying, infantilizing, and just plain ignoring patients because they have an “I know better than you do approach.” It’s scary and heartbreaking.
We desperately need a new generation of nurse-owned practices to give patients the time, knowledge, and support they need to make informed decisions. We got into this industry to help and heal. Together, we can evolve how we integrate these core values within the healthcare profession.
Veronica Pike
FNP-C President & Co-Founder
Veronica co-founded Med2You, a healthcare company based in Austin, Texas that provides primary and psychiatric care to underserved populations with a completely remote care team led by nurse practitioners.
Veronica started her business as a single provider with a mobile “doctor bag,” cellphone and a laptop.
As a family nurse practitioner and entrepreneur who has operated her own practice since 2013, Veronica knows the unique challenges and needs APNs have when navigating the business, legal and regulatory components of starting and operating a thriving healthcare practice.
Now, her mission is to put this knowledge in the hands of other advanced practice nurses so that they can realize their full potential as clinicians, entrepreneurs and leaders in their community.
With her business partner, Griffin Mulcahey, a healthcare regulatory attorney, Veronica has designed the educational programs, resources, and community support network that is the American Academy of Nurse Entrepreneurs (AANE).
Veronica is also a sought-after speaker around the country. She speaks to healthcare entrepreneurs, clinicians, hospitals, and associations – proudly educating and helping the growing community of healthcare entrepreneurs who are giving more options and better care to communities around the country.
Practicing Patient Autonomy Within Your Practice
Patient autonomy has become a buzzword in our industry and it tends to be discussed like a philosophy, but rarely in terms of actual patient interaction. So, today I'd like to share some insights about patient autonomy and how you can approach it in your practice.