Patient Engagement – Here’s The Key To Success In Case You Are Interested

Primary care physicians are the point of first contact that people like you and I have with a hospital or health systems.   We are 13 times more likely to visit a primary care physician in any given year than we are to need a hospital stay.

Primary care physicians are very important.   Yes they are they the first line of care for many people.   The primary care physician’s office is also the  “make or break” point for “engaging the patient.”  

What people experience have experienced in primary care physicians’ offices  in the past tends to “shapes and frames” their expectations of future health care experiences.    Patient complaints about doctors that don’t listen, long waits, etc. are as much a reflection  of our collective life-long experience as they are the reality of any one physician.   So it is with the tendency of patients  to stay disengaged from their health care.   That’s what we as patients are taught from childhood.

This post is the 3rd in a series of posts on Patient Engagement.  Be sure to also check out:  Patient Engagement Versus Physician Engagement – Which Comes First? and Patient Engagement From The Patient’s Perspective.

What’s the Point?

The point is that the medical exam – the most frequent point of contact between patients and the health care – was never designed to engage patients.  This is the same “medical exam process” taught in medical schools to this day.

The medical exam is a highly structured affair.  It doesn’t just happen.   It consists of 6 steps or processes that physicians move the exam through with the single goal of diagnosis and treating the medical problem

The most important “take away” from this graphic is that patients – people – are invited to freely speak only during the 2^nd step – the patient’s opening statement.  This is where people tell the doctor the reason for their visit.   Even then…patients are often interrupted before finishing their story.

From this point of the medical exam on, the patient’s role – aka the sick role – is to answer yes or no to their physician’s questions.

How can physicians, hospitals or health systems ever hope to truly engage patients in their own health  care when the heart of the heart of the health care system – the medical interview – is so un-engaging?

The Key to Patient Engagement – High Quality Patient-Centered Communication

Patient-centered communications by definition is tailored to the patient – their beliefs, fears, concerns and past experiences.   It invites patient input and participation.   It engages us in important conversations with our physician that would not otherwise occur.   When practiced over time, patient-centered communications will enable physicians to accomplish more…in shorter visits…while creating exceptional patient experiences.

Hospitals, health plans, and ACOs looking to engage patients should begin by looking to ways to help their physicians adopt more patient-centered communication skills.   Simply providing them with EMR systems and care coordinators is not enough.   Going forward, those physician groups and hospitals most successful at engaging patients will be the ones that are the most patient-centered where it counts – physician-patient communications during the medical exam.

That’s my opinion…what’s yours?

Sources:

Haidet, P., & Paterniti, D. A. (2003). Building a history rather than “taking” one: a perspective on information sharing during the medical interview. Archives of Internal Medicine, 163(10), 1134-40.

Cegala, D. J., McClure, L., Marinelli, T. M., & Post, D. M. (2000). The effects of communication skills training on patients’ participation during medical interviews. Patient Education and Counseling, 41(2), 209-22.

Patient Engagement Versus Physician Engagement – Which Comes First?

It is said that “turn around is fair play.”

So if providers (physicians, hospitals and other health care professionals) expect patients to become more engaged in their own care, isn’t it fair for patients to expect their physicians to also get more involved in their care?

If you look closely at “proxy measures” for physician engagement, you will see that this is a legitimate if not equally important line of inquiry.

Hello? Hello? Anyone There?

Take “listening” as a proxy for physician engagement.  The importance listening was underscored back in the 1880’s by of Sir William Osler, the founder of modern medicine, who said “listen to the patient they will tell you what’s wrong.”   Listening to patients was and continues to be a challenge for providers.   Research shows that on average, physician interrupt our (remember we are patients sometimes too) opening statements within 18 seconds.  This is significant since the “opening statement” is where we are telling the doctor the reasons for our visit.   Not surprisingly, being a “poor listener” is a chief complaint patients have about their physicians.

How do you feel when a friend, a colleague, or your spouse interrupts you when you are trying to make a point? 

Ignoring certain patient “cues” is another proxy for physician engagement.  Depression is a great example of an entire category of topics, e.g., psycho-social issues, systematically ignored by many physicians.  Opening the “Pandora’s Box” of depression, anxiety, etc. can take a lot of time and push the physicians’ skills limits, but patients who bring it up are suffering and want to be heard.

How would you feel if you were obviously bleeding from a wound and your best friend was too busy to bandage your bleeding wound?

Telling patients to do something that they are philosophically against is yet another proxy measure of physician engagement.   A lot of patients for example don’t believe in taking RX medications as the first course of treatment.  Yet a lot of patients feel that is exactly what happens.  Physicians, due to a lack of time or a belief that patients are inherently adverse to life style change, prescribe an RX medication for high cholesterol, high BP, etc. as the first course of treatment.

How likely are you to fill a prescription that you didn’t ask for and don’t want?

Yes physicians are too busy…yes physicians are not reimbursed enough.  But you can say the equivalent for us patients – we are not listened to, we are objectified as a disease, and we are not understood or respected as a person.

You get the point.  Engagement is a two-way street.  If physicians and hospitals want patients to become more engaged then they are going to have to become more engaged.   Engagement, like so many social behaviors, is reciprocal.   So how are you measuring physician engagement in your organization?

That’s my opinion. What’s yours?

This post is the 2nd in a series of posts on Patient Engagement.  Be sure to also check out:  Patient Engagement – Here’s The Key To Success and Patient Engagement From The Patient’s Perspective.

Sources:

Dyche, L., & Swiderski, D. (2002). The Effect of Physician Solicitation Approaches on Ability to Identify Patient Concerns. Family Medicine, 267-270.

Henke, R. M., Zaslavsky, A. M., McGuire, T. G., Ayanian, J. Z., & Rubenstein, L. V. (2009). Clinical inertia in depression treatment. Medical Care, 47(9), 959-67.

Street, R. L., Krupat, E., Bell, R. a, Kravitz, R. L., & Haidet, P. (2003). Beliefs about control in the physician-patient relationship: effect on communication in medical encounters.  Journal of General Internal Medicine, 18(8), 609-16.