The United States healthcare system is responsible for several crowning achievements, modern innovations, and…failures. Among those failures is the creation of helicopter patient care. You’ve heard about helicopter parenting, the overbearing, over-anxious, micromanagement of children – but we’ve been adopting a similar philosophy when it comes to patient care and patient communication. It might be naïve to assume that helicopter patient care comes from a place of good intentions, but it has the acute ability to strip patients of their autonomy – something that has a ripple effect throughout the entire ecosystem.
Paternalism is perhaps the most established of these two parents. Assertive and dominating, paternalism strips a patient of the confidence to be an active participant in their own healthcare journey. The hubris of paternalism is such that it imposes a sense of authority and obedience on the provider and the patient, often leaving the patient in the dark, surrendering to the recommendations of their physician without ever truly realizing the implications. Physicians do not always recognize their own paternalistic behaviors, especially when they believe that they are acting in the best interests of their patients – but that does not make it any less harmful. The inability to make an informed decision ultimately is the removal of patient autonomy – something that can result in high healthcare costs, insurmountable medical bills, and even misdiagnoses.
Paternalism’s subtler, though equally damaging counterpart is what we at Advize Health refer to as maternalism. Whereas paternalism is largely facilitated by the physician’s themselves, maternalism’s roots are far more institutionalized. Maternalism is the United States’ reliance on health insurance. While this particular parent affects a more specialized group; those who have the privilege of quality or commercial health insurance, it is a pattern that has cemented itself within the fabric of the industry. It manifests in the form of a question that we have heard a million times, in a question that we may have even asked ourselves:
Insurance pays for it, so why should I care?
The apathy that comes with having health insurance is another way to excise patient autonomy from the care equation. We are mothering our patient base to the extent that they no longer feel the need to educate themselves on diagnoses, prognoses, treatments, and procedures. They will blindly follow a physician’s recommendations (with or without paternalism present) – simply because their insurance is footing the bill. Maternalism may be the quieter, less assuming of healthcare’s two problematic parents, but it is responsible for increased healthcare expenditures, and this is creating quite a heavy burden for insurance companies, who are then forced to look into medical necessity and a plethora of other questionable practices. The comfort and complacency that is awarded to those who are able to use insurance as a tool is taken for granted, causing patients to willingly hand their autonomy over to the system.
Healthcare professionals have a tendency to refer to patients by many names before settling on any one, in the same way parents might call their children the name of their sibling when there’s a few too many running around. We call patients members, beneficiaries, victim…the list goes on and on. This too removes the accountability from healthcare – both for us and for the patients themselves. In order to begin combating the effects of helicopter patient care, we must recognize the significance of accountability for all participants. Providers must allow their patients to think freely, to ask questions, to be confident enough to communicate. Payers and insurers must encourage patients to communicate as well. Insurance is a privilege that not all are lucky enough to obtain, it cannot and should not be abused or used to make uninformed decisions.
Helicopter parenting and patient care remove the liberty of choice from children and patients. As much as we believe we are acting in the best interest of those under our care, part of education and learning is the opportunity to investigate, inquire, make mistakes, and participate. Healthcare as an industry will not improve if we take the power and autonomy from the very people who allow it to grow, the patients.