Ithaca Free Clinic, Ithaca, NY. November 8, 2018

Walk Like A Clinician
Lessons Learned Working at the Ithaca Free Clinic #1
Patient Agency and Useful Questions

I have been working as a clinical herbalist at the Ithaca Free Clinic for the past 12 years. It is a continual learning experience on many levels and from many perspectives. I recently started putting together some of the ideas I feel I have learned while working there. Thank you to the current apprentices for helping with this.

This will be the first of a number of similar posts. I am partially writing this for myself to consider what I am learning, as it helps me to continue to improve my skills as an herbalist, health provider and human. And hopefully, it has interest for others reading this.

Patient Agency

The concept and practice of patient agency is important in health care. It describes helping empower individuals to be a part of the decision making process for their treatment and other aspects of their health needs.

Many people I see feel upset, frustrated, minimized and angry by the way they have been treated in the medical system. I am not trying to place blame as there are many caring people involved at all levels, but the experience of being treated dismissively is common.

While there is not much I can do outside my sphere at the free clinic, I hope to help patients feel that they can have more autonomy about their health.

During a consultation, I try to ask questions that help people understand the nature of their condition and their options in going forward. There are many questions and approaches we can use that can encourage patient agency. And hopefully this helps them become better advocates for themselves and/or others.

I worry that this discussion may sound patronizing, or self-promoting. But I write this in the hope that it is seen as widening the discussion amongst herbalists and allied healthcare workers to help provide safe environments, and increase informed consent.

7Song working in the herb room at the Ithaca Free Clinic. October 4, 2018


Please note-this is a list of possible questions and approaches. A lot depends on the individual as well as the practitioners’ relationship with the individual.

  1. Education and information are helpful, but it is also possible to over inform.
  1. Let people know why you are asking them specific questions
  1. Similarly, if I am writing something down during a consultation I can explain the importance of what I am writing.
  1. When asking certain types of questions it is respectful to let a patient know they don’t have to answer it.
  1. It is even more important to get consent where touching is involved such as with palpating an injury.
  1. Asking open-ended questions can be helpful
  1. A question I find helpful at times is ‘what is your concern about your condition?’
  1. ‘How do you feel about your health’ is a useful question to open the door into more insights in how they feel about their physical, emotional and mental health.
  2. A very useful question is “If the treatment could change one thing, what would be different”, or ‘If I could magically but realistically change one thing, what would be different’?
  1. Letting people know what you are giving them and why
  1. You can also describe why they are taking certain preparations and dosage.
Ithaca Free Clinic herbal room with apprentices Joe, Alex and Kalo. November 8, 2018
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