Remember when patients were told by their doctors, “Take two of these and call me in the morning”? We have long been taught to trust our doctors. After all, they take an oath not to harm, right? Then how did the doctor-patient relationship turn sideways, as seen in the current drug epidemic in this country?
The phrase, “Do no harm” or “Primum non-nocere” is not part of the Hippocratic Oath, as many of us assume, but actually from another of Hippocrates’ works Of the Epidemics. Regardless, why would anyone ever question the advice of our trusted family doctor?
Instead, the answer for many should be “Why wouldn’t we question it?”
Authoritative Approach Is the Do-What-I-Say of Medicine
While many people don’t give treatment approaches a second thought, I want to shed some light on the differences between the authoritative approach in care, compared to the collaborative approach we use at the Alternative to Meds Center.
An authoritarian approach draws a line between patient and practitioner. It relies upon the principle that the doctor knows best and does little to involve patients in the assessment process or decisions regarding their treatment. In the authoritative model, doctors dictate the course of treatment—period. There is little to no input from the patient on the assessment, nor the treatment. This approach can put the patient in a position where they feel powerless and compelled to follow whatever advice is doled out.
You wouldn’t handle a job opportunity in that way as it has an impact on your livelihood, especially when it comes down to negotiating your pay grade. Why wouldn’t you want to engage in a conversation about your health? You deserve to know the ins and outs, benefits, and potential pitfalls of your medical decisions.
So how did patients not only become so passionless and powerless but come to believe this is how it has to be?
Shift in Health Care Started at the Top
Health care has shifted in the last 40 years. President Nixon passed the Health Maintenance Organization Act in 1973 which allowed, for the first time, health care organizations to begin operating as for-profit businesses. Since that bill, there has been a dramatic shift in how we receive healthcare in the U.S.
Priorities have shifted, but patient perspectives on the power they give to physicians didn’t.
The Patient Experience Is at a Shortfall
Psychiatrist visits changed from 45-minute talk therapy sessions to 15-minute medication consultations, largely due to the way insurance companies structure their billing policies. How much can someone really know us after a 15-minute conversation? Apparently, well enough to prescribe a mood-altering substance that we may or may not develop a lifelong dependence on…. It’s no wonder why a growing number of people have a toxic affair with prescription medications. Is there any other kind?
These changes in policy and incentives from drug companies have led to a new paradigm in how we administer and receive mental health treatment. Medications are offered first, before collaborating with the patient on finding alternatives such as therapy, exercise, diet, or other lifestyle modifications. This can leave the patient feeling like they have limited options for help. In addition, because many view the psychiatrist as their personal authority on mental health, this often leads us to accept the one, single option being offered.
The Difference a Collaborative Approach Can Make
Trust is earned, over time and through results, which is an entirely different concept than what is found in the authoritative approach. However, it resides in the collaborative approach to healing.
This model works to empower patients in the healing process by asking for their input on the assessment, diagnosis, and treatment. It draws upon the individuals’ unique perspectives and insights into how they feel, what their condition presents, and the opportunity to choose the treatment option they feel most comfortable with.
The collaborative model places every patient as an important member of their treatment team, empowering them more to care for themselves. Isn’t that the point? The more a person chooses to exercise self-care in health matters, the patient-physician relationship will benefit for all the right reasons.
Our society places high esteem on licensed medical and clinical practitioners, doctors especially. Traditionally, doctors have acted and been treated as the ultimate authority on anything medical concerning our bodies. We visit the hospital or the doctor’s office and then follow the recommended course of treatment, often without question. But something changes when our general practitioner pulls out a prescription pad and puts us on a drug; more specifically, a drug that will create a dependency and sometimes will be recommended for a lifetime.
Is this an abuse of power: Perhaps on both patient and practitioner.
Patients Need to Own their Mental Health
We have been taught to take the advice of our doctor without question, which can lead to problems. Doctors today make it a practice of handing out medications liberally without much investigation, education, or collaboration with the patient.
Statistics show the use of psychiatric medication is steadily on the rise. According to a report released by the National Center for Health Statistics (NCHS), the rate of antidepressant use in this country increased by almost 400 percent, between 1988–1994 and 2005–2008. And according to published reports on adult use of antipsychotics, data shows that use of atypical antipsychotics in adults has soared over the decade, up more than 3.5 times, from 2001‐2010.
As the number of psychiatric medications being prescribed in the United States continues to grow, our awareness and self-advocacy will need to grow alongside. Patients cannot afford to blindly follow the advice of doctors any longer. Rather, they should question, investigate, and empower within to make the right choices for themselves and their loved ones. Every mental health treatment should be made with the patient, not on their behalf. By implementing this collaborative approach to healing models, we can receive the care we need while feeling supported, respected, and heard. As it should be.