It has come up in a number of my recent appointments with natural family planning (NFP) clients that they were given instructions from their healthcare providers without being educated in any way on why they were choosing a particular course of action or what consequences those actions could have. In one case, a woman was told there was no way to find out the source of her gynecologic health issues and that her life would just be better if she got on the Birth Control Pill (BCP). This woman was very disillusioned with her experience and was also made to feel helpless and broken, with her perception of self-efficacy in the metaphorical pits. Now, it is very likely that what this provider should have said was something like, “Your collection of symptoms does not easily point to any one diagnosis, so it is likely that if you want to pursue this further, it would require quite of bit of time, energy, and money to do more testing.” Instead, this woman was given a prescription and told to come back in a few years when she wanted to get pregnant. Yikes.
This is a common trend in healthcare. We assume that clients are too ignorant to participate in their own healthcare decisions. Don’t get me wrong. I believe there are many people that would make poor healthcare decisions on their own behalf, if it was completely turned over to them. However, the solution that we have chosen for this problem is completely wrong. Instead of empowering our patients through education so that they can make better decision on their own behalf, we make decisions for them and take away all of their self-efficacy and autonomy.
There are a number of causes that led to the trend of circumventing our patients’ autonomy.
- Insurance and other sources of red tape have minimized our time to educate patients. In a world where physicians spend about 10 minutes with each patient, they are just desperately trying to get through an examination. It leaves little time for educational interventions.
- We are told to assume that patients have only a 5th grade reading level. Let’s be honest, it is really hard to speak in layman’s terms to patients when there is jargon that so much more efficiently articulates our thoughts. This feeds into the first cause; we don’t feel we have the time to walk through this potential black-hole of patient education (that we spent years in school for).
- There are so many sources of bad education that our patients can access that we assume their thoughts and opinions will have already been biased by these bad sources. We will call this the WebMD effect. I am not speaking directly against the value of WebMD information, but it is well-known that anyone can find out they definitely (total sarcasm) have cancer if they look long enough on these sites. This is simply a can of worms that many doctors don’t want to open. The simple solution? Just quickly speak over a patient’s head and make decisions for them.
But there are also a number of great reasons to include your patient in decisions through education!
- Patients are way more likely to comply with a medical intervention if they understand why they are doing it.
- You build trust and rapport with patients by allowing them to feel your concern about not only their health but also their peace of mind. Let your patients know that you care about them leaving the office with their questions answered.
- Patients will become historians with proper education. If you want a patient to be able to more accurately report their progress, evolution of conditions, or new symptoms, you can give them those tools through education early and often. It will make your job easier in the long run!
- A patient should be the true expert on their own body. As healthcare providers, we see the patient for maybe an hour per week/month/year depending on what field you are in. So we need to empower patients to become experts on their health and wellness. That only comes through education.
What does this have to do with NFP?
I believe that NFP is a fantastic form of healthcare that allows us to optimize our patients’ health and wellness. Unfortunately, many providers still question the practicality of NFP because of the previously listed obstacles; they are taught to assume that their patients will have low compliance and poor health literacy. However, NFP is absolutely the best solution to improve health literacy and compliance in family planning, since it is entirely based on education and creating self-efficacy (which naturally improves compliance). Is there anything better in healthcare? We create better historians to help us do our jobs more easily in the future, and we create fantastic buy-in to healthcare by allowing women to be experts of their own body, as they should be.