Empowering to disempower

A few days ago I saw an article about empowering patients in my Twitter timeline. This time I’ve had enough of ‘empowering me’. So here is my rant of a blogpost.

But before writing the rant, I decided to check what medicine tells me about patient empowerment. I googled patient empowerment and here are a few quotes from the first few hits:

The term chosen to engage and involve patients will depend on what is appropriate for the specific culture of a region or community. (WHO guidelines)

The Department of Health and Human Services is working every day to put patients and their doctors at the center of American health care.

Incidentally, patients write in a similar way:

Patient empowerment puts the patient in the heart of services. It is about designing and delivering health and social care services in a way, which is inclusive and enables citizens to take control of their health care needs. (European Network on Patient Empowerment)

Then I googled “patient empowerment NHS” and here are a few snippets from NHS England’s initiative to empower patients and communities:

We must fully harness the renewable energy represented by patients and communities

Building on the role and resources of people has long been an aspiration of the NHS, but real change has been hard to achieve. NHS England is making this grant available to enable services to build on the resources of the local community, and empower patients to take control of their own health and care

Building on the role and resources of individuals, and supporting them to manage their health and have a greater say in their care is a joint aim of both public health and NHS care.

Before I comment, please, let me just say: Can it get any more bloody patronising?! Please, please don’t build on my ‘resources’ (I am trying to be very polite here).

But let’s get linguistic. What is absolutely amazing about all these quotes (I do encourage you to search for more) is that empowering is something done to patients. So medicine (and medics) ‘involves’, ‘puts’, ‘enables’ people and of course ‘harnesses the people’s energy’.  It gets only worse in the NHS quotes and I don’t even mean these dreadful economic undertones. In the NHS they start by not even engaging with people. Oh no, in the NHS they start by doing  things to ‘renewable energy’  or to ‘role and resources’.  Only later do they ‘support’ individuals. And what the bloody hell is ‘harnessing the renewable energy represented by patients and communities’. Well, to be completely honest, I don’t want to know.

And here starts my rant. You see, my problem is that all this talk is, in fact, disempowering. For medicine and medics are represented as simply exercising their power and deciding to empower me. The all-powerful medicine decided that I might actually be allowed to have a say. I mean, isn’t it just so nice and gracious of you? Should I now be eternally grateful to you?

There is no togetherness, no sharing, no joint responsibility. It’s all about powerful people allowing me to be ‘empowered’. And to be completely honest they can shove this empowerment…. Because I will not enable you to construct this total asymmetry of our positions. And this is exactly what really angers me in all this. These texts pretend to do me this big favour, putting me in the centre and all that. But in fact it’s actually, I’m sorry to say, quite pernicious – what they accomplish for the most part is reinforce the imbalance of power between us. Yes, you decide to empower me (it is soooo very much your decision, innit?) and me gratefully receiving your empowerment! Oh yes, my only decision is just about how low I bow in gratitude.

So, please, spare me empowering me!

You might think it can’t get any worse. Well, think again. The first text I linked above did contain the actual definition of empowerment by the WHO:

A process in which patients understand their role, are given the knowledge and skills by their health-care provider to perform a task in an environment that recognizes community and cultural differences and encourages patient participation.

I suppose, I should be grateful that at least there is no decision to empower me. But then there is the hit. I, the patient, will be:

given the knowledge and skills by their health-care provider to perform a task

I mean – really?!? Your kindness, doctor, clearly knows no bounds. I come to see you, ignorant as I am, and you, so knowledgeable, simply give me the knowledge. How will I ever be able to repay you? Will it be enough, if I simply soak up your words, in awe of your wisdom and knowledge? Or should I also come in slightly stooped, not looking up, apologising for taking your valuable time?

And here we come to my standard finish. Once again, there are no offensive words, nothing to campaign about, nothing to say ‘It’s OK to talk’ about. It’s all about grammar. And it is the grammatical form which is, quite frankly, offensive. Yes, language matters, so how about stopping to ’empower me’. Really. Don’t do anything. Just….(what I wanted to say here cannot be written in a polite academic blog).

Oh, you might also consider some reflection on what you actually say to and about me.  Just saying…



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