Can a patient create their own treatment plan?

Can a Patient Create Their Own Treatment Plan?

No, patients cannot and should not create their own treatment plans independently—treatment plans must be developed collaboratively through shared decision-making between the patient and healthcare professionals, with the clinician maintaining professional responsibility for ensuring medical appropriateness and safety. 1

The Collaborative Model: How Treatment Planning Actually Works

The evidence consistently demonstrates that effective treatment planning requires a partnership model, not patient autonomy alone:

Professional Oversight is Essential

• Healthcare professionals must guide the planning process by conducting comprehensive assessments including the patient's needs, preferences, pain characteristics, current disease status, and pain-related factors such as disability, beliefs, emotions, social influences, sleep problems, and obesity 1
• The clinician formulates the management plan together with the patient and family, but this occurs within the framework of evidence-based treatment options and professional medical judgment 1
• Treatment goals and plans are created WITH patients based on individual preferences, values, and goals—not BY patients alone—taking into account age, cognitive abilities, health beliefs, support systems, cultural factors, disease complications, comorbidities, and life expectancy 1

The Patient's Critical Role

While patients cannot create plans independently, they must assume an active role:

• Patients should disclose the impact of their condition on daily functioning, express their ideas and concerns about their condition, and communicate their expectations and preferences for treatment 1
• Patients establish their functional and valued life goals—what they cannot currently do that matters to them—which guides the treatment planning process 1
• Patients participate in setting treatment goals within the collaborative framework, but the healthcare team ensures medical appropriateness 1, 2

The Stepped-Care Approach to Personalized Planning

The treatment planning process follows a structured algorithm 1:

Step 1: Education and Self-Management Support

• All patients receive educational materials, psychoeducation from healthcare professionals, and access to self-management interventions 1
• Patients learn skills for self-management, but within professionally designed frameworks 1

Step 2: Specialist Treatment Options

• If indicated based on professional assessment, patients receive specific interventions (physical activity, orthotics, psychological interventions) 1
• Referrals to physiotherapists, occupational therapists, or mental health professionals occur based on clinical judgment 1

Step 3: Multidisciplinary Treatment

• Complex cases require coordinated care from an interdisciplinary team including physicians, nurses, dietitians, pharmacists, and mental health professionals 1

Why Professional Guidance is Non-Negotiable

Medical Complexity Requires Expertise

• Assessment of current inflammation, joint damage, or disease progression as sources of symptoms requires clinical evaluation that patients cannot perform themselves 1
• Determining whether existing treatments are adequate demands professional medical knowledge 1
• Identifying contraindications, drug interactions, and safety concerns is beyond patient capability 1

Legal and Ethical Framework

• Patients have the right to informed consent and to participate actively in decisions, but this occurs within a framework where healthcare providers give information about treatments, associated risks, side effects, and alternatives 1
• In emergency situations, medically necessary interventions may be carried out even without explicit consent, demonstrating that professional judgment supersedes patient autonomy when safety is at stake 1
• Advance care planning documents (living wills) express patient wishes, but positive living wills (requesting specific interventions) are not legally binding on healthcare providers, while negative living wills (refusing interventions) are binding 1

Common Pitfalls to Avoid

The Illusion of Complete Patient Control

Research shows a significant gap between ideal and real treatment planning 3. Providers understand evidence-based principles but face obstacles in implementation. The solution is not to hand planning entirely to patients, but to improve the collaborative process through better communication, adequate time for discussions, and system-level support 3.

Confusing Self-Management with Treatment Planning

• Self-management education teaches patients skills to minimize symptoms and implement agreed-upon plans 4
• This is fundamentally different from creating the treatment plan itself, which requires professional medical assessment and evidence-based treatment selection 1

The Recovery Planning Exception

In social model substance abuse programs, clients develop their own "recovery plans" with peer and recovering staff oversight 5. However, this occurs within a structured program context and represents a philosophical approach specific to addiction treatment, not a general model for medical treatment planning 5.

The Optimal Approach: Patient-Centered Collaborative Care

Use patient-centered communication that employs person-centered language, active listening, and elicits patient preferences and beliefs while assessing literacy, numeracy, and barriers to care 1. This optimizes health outcomes without abandoning professional responsibility.

The healthcare professional becomes a skilled companion, exploring what matters to the patient as a person, then determining mutual goals of care first, and subsequently determining the best way to achieve those goals 6. This person-centered conception of shared decision-making maintains the essential professional role while genuinely incorporating patient values 6.

Document the collaborative process thoroughly, including the patient's expressed needs, the professional's assessment, and the evidence-based rationale for the chosen treatment plan 1. This creates accountability for both parties and ensures continuity of care.