What You Permit You Promote

This aphorism is useful in many settings, including when talking about person-centred care (PCC) and about patient engagement, without which PCC will never achieve its promise.  It’s relevant because when communities and citizens continue to accept non-person-centred healthcare, they are effectively promoting non-engagement.

The following anecdotes are revealing. I talked this week with a woman who is fearful about her next doctor visit. She knows he will press her to take a somewhat experimental medicine for her chronic disease. She doesn’t want this. She will have to speak up but doesn’t know how and is afraid. Her fear suggests her healthcare provider may not always employ a shared decision-making approach. By chance, I fell into another conversation about healthcare this week with a man who also suffers from a chronic disease, one with many features. “When I think of my medical care,” he told me, “I think of my car. I see one healthcare provider and they deal with the brakes. Another focuses on the tires. The next one only wants to discuss my carburetor. On and on it goes. But no one seems to be considering my whole car.” Does this sound like PCC care to you?

If a person-centred healthcare system is to be achieved, a greater degree of patient engagement must exist. Patients must learn to demand a different style of care, one built upon partnership and an understanding of the whole person. How do we accomplish this? By working together.

Fortunately, it is possible to identify several Canadian collective initiatives intended to enhance patient engagement to which citizens can contribute. For example, patient input has resulted in healthcare provider education that is increasingly focused on the importance of patient engagement (a change to which ICN is contributing at the University of Calgary); Healthcare Excellence Canada is devoted to patient safety and health system improvement; there are various efforts in Canada advocating for a Patients’ Bill of Rights and SPOR is devoted to ensuring that citizens have meaningful input into the prioritization of clinical research activities. Locally, Alberta Health Services has developed programs to educate and support citizens in the advancement of patient engagement. Group advocacy efforts that allow and promote patient engagement are alive and well in Canada.

But what about smaller change initiatives focused on individuals and the role they play in promoting patient engagement in health and healthcare matters? In Alberta, ICN is a leader in organizing such efforts through community conversations and focus groups, through the creation and dissemination of digital health stories, through its focus on ensuring proper management of patient concerns, and through specific programs that engage the population on topics such as health literacy, digital health, and child and youth mental health.

What you permit you promote. The more engaged that citizens and patients are with their healthcare system, the more it will treat them as genuine partners. There are many opportunities for such engagement, including volunteering with ICN or joining an upcoming event.

About the Author: Robert Bear is an ICN volunteer and Board Member. He was previously a Professor of Medicine at the Universities of Toronto and Alberta, and is author of the medical novel “Sorrow’s Reward”.

November 2021