A Culture of Empowerment, a Culture of Health

Jul 22, 2013, 4:15 PM, Posted by

Doctor examines a patient in hospital room

The thin, paper-like hospital gown. Open. Exposing. Awkward. The perfect symbol for what health care in America represents for most of us.

As a bit of context, last week I spent three days with a group of amazing women from across the health care industry at an RWJF-sponsored forum hosted by the Association of American Medical Colleges. At that meeting, a key part of the discussion centered on where the opportunity for meaningful, collective, action might lie to catalyze dramatic system transformation. More than once, the hospital gown metaphor came up.

To me, though, this symbol represents much more than a call for system transformation—I see it as a battle cry for empowerment.

Let me explain.

First, the hospital gown is a powerful reminder that care is delivered at institutions, special “places” we go for health. In these places, people become patients (quite fittingly, Latin for “one who suffers”), and assume different and unequal footing with the providers caring for us—to the point of putting on special, uncomfortable clothing designed only with the provider in mind, that immediately makes us feel vulnerable and self-conscious.

That vulnerability is also part of the road we take to getting into the doctor’s office or hospital in the first place. Rather than, as empowered consumers, having the ability to seek out reliable and understandable information to help us make the best choice about a doctor, we often rely on a recommendation from a friend or family member, and if we get lucky, that particular provider accepts our insurance. If we’re unlucky, or just uninsured, we often go in with no idea about how much the visit will cost us and therefore no ability to shop around—worried that if the doctor finds something unusual or wants to run an unexpected test, we’ll have to go with it, scared and unsure about what that might mean for us, medically or financially.

And importantly, that vulnerability also extends to our relationships with our communities—which have a dramatic impact on how we experience health outside of our doctor’s office in many ways: our ability to exercise, access healthy foods, feel safe, breathe fresh air, drink clean water, and feel connected with others. We might be fortunate enough to choose the communities we live or grow up in; maybe not. But either way, our ability to push for changes that positively impact our health in our communities varies substantially from place to place.

All of this, to me, is what the hospital gown represents: a complete lack of power for each of us, as people, to “own” our own health and wellbeing. But it also underlies the promise of what a true culture of health can bring—a future in which information no longer only resides with the clinician, hospital, or insurance company and instead resides with everyone; where relationships between people and their health care providers are true partnerships; and where ZIP codes no longer dictate health because communities everywhere are flourishing under the popular expectation that health is an important part of life.

It is a future and a culture where empowerment exists and is reflected before, during, and after we walk into a doctor’s office.

And it includes hanging up that gown for good.

Andrea Ducas / RWJF

Andrea M. Ducas, MPH, is a program officer with the Robert Wood Johnson Foundation working with programs related to payment and delivery system reform, purchaser and consumer engagement, health care price transparency, community-driven health improvements, and strengthening health departments. Read her full bio.