Patients Are Often More Engaged In Their Health Than Providers Think

Patients often don’t get the respect they deserve. Take the subject of patient engagement.  Just about everywhere you turn in the health care literature these days we are told how physicians and other providers need to do a better job getting patients involved in their own health.

But is that really their role?

Patient Engagement Is Not The Job Of Health Care Providers

Why?  Because by the time a person (aka patient) presents for care in the primary care physician’s office…they are already engaged in their own care to some degree…albeit now necessarily in the way providers expect.   Here’s what I mean.

People consult with their doctor when they have a need or concern which they believe needs to be addressed.  Often times before they make an appointment to see the doctor, people will do their own home work to see if a doctor’s appoint is really necessary.   Many of us for example will talk with a friend or family member or consult our favorite health website before deciding to see a doctor.  A recent Wolters Kluwer poll on Health found that of all people who go online for health information, 50% do so before seeing their doctor.

Next we must pick up the phone and make the appointment which itself requires time and dedication given office hold times.  Then we must actually keep the appointment…telling ourselves that we are seeing the doctor for a good reason.

By the time we walk through the front door of the doctor’s office we are already engaged in our health as manifest by the cognitive involvement and expenditure of time involved with:

1)    Deciding that we need to see a physician,

2)    Making and keeping their doctor’s appointment despite the self-talk that we will get better on our own.

3)    Preparing a mental list of issues/question that we want to discuss with the doctor.

Given that people 50 years and older see their physician and average of 3-4 visits a year, they are already engaged in their own health…at least up until the time they walk into the physician’s office.

What happens in the doctor’s office plays a big role in determining whether the patient’s level of engagement grows, or is diminished if not extinguished.  Physicians that are prepared for the visit, ask patients for their input, solicit patient expectations, beliefs and previous experiences, and where possible honors them, are demonstrating traits that patients find engaging, e.g. traits which encourage patients to persevere in their get involved in their health.  Physicians who appear rushed, “not present,” not prepared, or who fail to solicit the patient’s input often have the opposite effect.

So What Is The Role Of Providers When It Comes To Patient Engagement?

Given that patients is the office are already engaged, albeit perhaps not is ways providers think of as engagement, the role of the provider is not so much one of needing to engage but rather being “.”  By engaging I mean creating an atmosphere which facilitates, cultivates, and builds upon the level of engagement which patients bring to the office.  This is accomplished when the physicians and provider staff consistent employ patient-centered communications with all their patients.

That is what I think…what’s your opinion?

If you like this post you will love my White Paper on Patient Engagement send me your email and I get you a copy.

Patient Portals. PHRs, & On-line Decision-Support Tools Alone Will Not Lead To Greater Patient Engagement

Patient engagement is getting a lot of attention these days, particularly in the health information technology press.   Anticipation of Stage 2 Meaningful Use criteria is certainly is driving much of the “talk.”  So too are the promises of improved patient outcomes and satisfaction associated with the adoption of patient engagement tools like EMRs, PHRs, web portals, and on-line decision support tools.

But if the mere availability of such health information technology was all there was to engagement…member use of health plan web portals, which have been around for years, would be a lot higher than they are now, e..g., often < 10% of members.

Patient Engagement Begins With The Patient-Physician Relationship Not Technology

If you were to take everything you read at face value, all physicians and hospitals need to to engage patients is patient or member web-based portal.  I guess the idea is if you build it…they will come. But there is a HUGE FATAL FLAW in that logic:

 Successful patient engagement is predicated upon the existence of a strong, trusting, mutually satisfying relationship between the patient and their physician.

Strong, trusting physician-patient relationships are becoming harder and harder to develop and maintain these days…for both patients and providers.   Poor physician communication skills, e.g., physician-directed communications, have been cited in the literature over last 30 years as a major barrier to more satisfying and productive physician-patient relationships. Poor communications also tops the list of patient complaints about their doctors.  Not surprisingly,  many patients find it easier to “get by” in an OK relationship with a primary care provider than seek a provider with a more engaging demeanor

What Are The Three Traits Patients Find Most Engaging In Their Provider?  Check out our latest White Paper

The Link Between Patient Use Of Engagement Tools And The Physician-Patient Relationship
So What Does A Strong, “Engaging” Physician-Patient Relationship Look Like?

Here’s my short list;

• Patients and providers like, respect, and trust each other
• Patients and providers are interested in and take the time to listen to where each other is coming from, e.g., their beliefs, concerns, etc.
• There is a high degree of agreement between patients and providers as to the visit agenda, diagnosis, treatment, and self-care options.
• Providers’ employ patient-centered communication skills

Imagine yourself in a relationship with a provider who simply doesn’t seem to dedicate much time or place much importance on the above traits. How likely would you be to spend your valuable time-sharing personal health information with someone who has never exhibited any interest when you attempted to share the same information in the past?

The Take Away

Don’t get so wrapped up in the promise of the latest health information technologies that you lose sight of what’s really important to patient engagement, outcomes and patient/provider satisfaction – the physician-patient relationship

That’s what I think…what’s your opinion?

If you like this post you will love my White Paper on Patient Engagement send me your email and I get you a copy.

Challenge #1 For Health Care Providers – Way Too Much Information And Way Too Little Communication With Patients

One of the biggest problems with health care today is that there is way too much information and way too little communications going on between providers and patients.

Here’s a great quote that explains what I mean:

The two words information and communication are often used interchangeably, but they signify quite different things. Information is giving out; communication is getting through.

Sydney Harris,  Journalist

I was reminded of this and the quote from “Cool Hand Luke” quote in an exchange I had with a primary care physician on LinkedIn recently.   In that exchange, which dealt with long-term physician-patient relationships, I hypothesized that intentional non-adherence may be the by-product of situations in which physicians and patients in long-term relationships simply grow to distrust each other.

The good doctor commented as follows:

“In the end, it is the patient’s decision to be compliant or not, yet many physicians continue to care for these patients because someone must. Would the patient comply better with a new doctor? I doubt it. “

I replied to the good doctor’s comment as follows:

“True…the decision to comply or not is up to patients.  But the evidence shows that compliance is not a product simply of bad patient behavior. Non-compliance is an outcome for which both physician and patient have shared responsibility.

I suggest that most people would be a lot more likely to comply if they: 1) understood and agreed with the need for the prescription and 2) believed that the benefits of taking the medication outweighed the risks and concerns. But these issues are seldom brought up by the physician or the patient, due to limited time, provider attitudes and beliefs about patient, and so on.”

Then he dropped the A-bomb – a move intended to silence anyone who would dare challenge physician authority and learnedness:

A professional who deals with this on a daily basis can explain meds, conditions, etc. very quickly and to the satisfaction of the patient.

That’s when it occurred to me…too much information and not enough communication

No doubt most providers today are proficient at quickly giving information to patients (including telling them what to do).  What most providers (and people in general) are not good at is effectively communicating, e.g.,  getting through, with patients (or each other).   Anyone who has ever been married knows the difference between information giving and communicating.

And how would the good doctor know that his patients understood the information he gave them…not to mention their being satisfied with it?   Surely he’s not banking his revenue going forward under P4P on his patient satisfaction surveys alone.

If anything, the weight of evidence suggests that his patients probably do not understand the information he quick doles out and probably are not particularly  satisfied with it.   Like many of us, his patients probably do not want to confront the good doctor choosing instead to ignore his recommendations or seek advice elsewhere, e.g., no-adherence.

But as with any good relationship, effective spouse-centered (I mean patient-centered) communications is key.   To truly engage the other party, you have to know where they are coming from, what’s important to them and never, never ask them to do more than they are willing and able to do.  I had to say that since my wife “proof reads” my blog posts…lol).

That’s what I think…what’s your opinion?