Health and sound health communication implies the existence of a contract between doctors and patients that goes beyond the medical consultation and strengthens the likelihood of successful outcomes to health interventions. In fact, the concept health education includes two important concepts—patient education and patient empowerment.

 

Since the mid-1980s, there has been an awareness of a disassociation that exists between chronic disease symptoms and patients’ perceptions of those symptoms. Asthma is a classic example. An early study revealed that a significant percentage of asthmatic patients underestimate the severity of the disease and may therefore be more at risk for mortality or morbidity. This information was succinctly highlighted in 2000 in the AIRE study, which showed that patients’ perceptions of asthma control did not match the severity of their symptoms, and that approximately 50% of patients reporting severe persistent symptoms also considered their asthma to be completely or well controlled.  

Among the many reasons for this phenomenon found in research settings, are poor patient knowledge of disease management, poor communication by physicians and undeclared symptoms. Furthermore, it is possible that this problem has been exacerbated by physicians’ failure to adequately screen for disease control and the continual passive reinforcement of sub-optimal control due to their lack of interest.

 

It has therefore been suggested that adequate consultation time should be spent with patients in order to uncover both subjective and objective evidence of control, and that focusing on issues that promote disease control might serve to minimise this important problem. Many tools and programmes are available for the achievement of these objectives.

 

However, the key idea of empowering patients to take control of their disease, to understand the condition and how it might be expected to develop, and how it should be treated has not been well promoted. Patients and prospective patients are now accessing the internet for information before and after visiting their doctors so as to self-diagnose. Based on the information they find, they decide what condition they have, what treatment is required and what the prognosis is. In this milieu the doctor seems to be superfluous. We know that that is not the case, but it is clear that doctors need help with effectively relating to their patients, who have to be directed independently to tools that support the correct diagnosis and management strategies. The internet does provide general information, but cannot diagnose individual patients and prescribe remedies for their specific needs.

 

In South Africa, some national societies have been exploring opportunities for this kind of ‘goal-directed’ insight for some time by developing credible website tools to educate patients.

It appears that what a patient with a chronic condition requires for the management of his / her condition is specific knowledge. This information should correspond to the information provided by the doctor, the internet, the pharmacist, the nurse and even the medical funder. If such good quality information starts circulating and is shared by neighbours, family and friends, who will all communicate the same message in a non-threatening way, the patient’s quality of life will improve.

 

However, probably the most important activity that will close the gap in the empowerment of patients while maintaining the involvement and up-skilling of medical practitioners is the linking of both parties by ensuring that patients are educated about their condition and that they are empowered by both their doctors and society to ask the right questions.

Empowered patients enjoy the benefit of better chronic disease control through access to targeted and valid educational materials that can:

The benefits of empowering and educating patients will accrue to patients and health care providers (HCP), funders, society and educators. This is the domain in which a paradigm shift is expected. The empowerment of patients will require more time and keener insight on the part of HCPs. The strategy of empowering patients to ask relevant questions is proposed in order to promote the triad of:

Patient education is the mandate of a number of medical organisations and societies. At the University of Pretoria, this philosophy is now being incorporated in both under- and postgraduate teaching, as well as in patient care clinics. This organisation is teaching medical practitioners to impart educational advice during each patient care contact. Based on the rationale that educated and empowered patients consume fewer health care resources. Medical aid organisations have also begun to explore the facilitation of contact between HCPs and their wellness programmes. This relationship is still in its infancy, but is expected to motivate patients to educate themselves by seeking more information from their HCPs. Those who drive this process will in turn motivate HCPs to focus more on patient education. 

 

Empowered patients will feel significantly more confident in demanding disease control. Everybody will win if we can succeed in significantly improving the communication of medical or health information.

 

Prof Robin J Green holds a PhD and DSc. He is the chairperson of the School of Medicine at the University of Pretoria, the Director of Paediatric Services at the Steve Biko Academic Hospital, a professor in the Department of Paediatrics and Child Health in the School of Medicine at UP, and a fellow of the Royal College of Physicians, the American Academy of Allergy, Asthma and Immunology and the American College of Chest Physicians. He is a former president of the College of Paediatricians of South Africa and former chairman of the Allergy Society of South Africa.