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.
Mind The Gap 
Reblogged this on HealthSkills Weblog and commented:
This post rang particularly true for me – both as a patient myself (who isn’t from time to time?!) as a clinician involved in helping people develop self management (which includes health literacy), and finally, as a researcher looking at the ways people who are resilient despite their chronic pain cope with their health condition. Whew! Sorry for the long sentence!
I don’t know that I completely agree that patient engagement isn’t for health care providers, because plenty of people are ambivalent about enacting their good intentions. This is where what we do counts most. Listening, helping establish what is important to the person, then supporting them to “take the next best step” for their health. This might mean giving them a call a couple of days later to see how they’re getting on, helping them set specific actions to take (time, date, what, when, where), and then reviewing how this is working some time in the future. Being proactive.
Thoughts?
Adiemusfree,
The provider’s role is to be engaging…not to try and engage. People come to providers “already engaged” with respect to the problem or concern that brought them into the office. Patients will find providers engaging to the extent that they are relevant, e.g., help them address their chief concern. Once engaged, providers may be able to expand that engagement to other areas over time.
Skills like listening are engaging to the extent that the patient perceives that you actually heard their chief concern as evidenced by your doing or talking about it. If you listen to the patient and then proceed to ignore what they said…you will not have much success.
Steve Wilkins
I do not agree with most of this article. Just because a patient visits their physician’s office 3 – 4 times a year does not mean they are engaged in their healthcare. And what goes on in the physician’s office does not make for an engaged patient. Some patients go to their physicians office and never change their lifestyle or habits. Engagement is just that: taking the time and commitment to actively and proactively be a part of something that makes positive difference. Today we are a society of obesity and yet we “engage” our physicians regularly. As a country the U.S. spends the most dollars per capita on healthcare costs than many other countries yet we are an obese society. Engaged; I think not?
Richard,
Thanks for your comments. According to Webster’s Dictionary, a person is said to be “engaged” when they are involved in doing something in which they have a great interest. By definition, the act of thinking about a medical concern , validating the concern through research, and setting and keeping a physician’s appointment meets the definition of engagement. As I said in the original post, the challenge for physicians is not to engage but to be engaging…to leverage the concerns which brought the patient into the office in the first place. To be engaging, providers must be seen by people (patients) as being relevant, e.g., someone who can help then solve their immediate problem or address their concern. Absent their concern…the person would not be in the office.
So the doctor’s visit represents a golden opportunity for providers to cultivate and expand the patient’s area of concern (their engagement). Let’s say they came into the office for a low back problem…e.g., they are engaged to the point of finding a solution for their back pain. They did not come in to the doctor’s office because they are obese..most obese people do not see themselves as obese according to the research. However, depending upon the physician, the patient’s weight can be brought into the visit as a contributing risk factor for further back pain. The patient’s concern can be expanded to included their weight. The reality, again according to the research, is that many physicians never tell patients they are obese…and never talk to patients about how to lose weight. Physicians simply are not trained in communications and behavior modification.
Provider tend to define engagement as people doing what they think people should do in their own best interest. That’s not engagement…that’s paternalism. Being an engaging provider means taking a little time (yes I know they don’t have any) to get to know your patient’s motivations and beliefs and to build from there. It ain’t rocket science.
Steve Wilkins
“Physicians simply are not trained in communications and behavior modification” – no, but coaches are 🙂 I see a huge role for health/wellness coaches to work alongside healthcare providers – I agree that paramount is starting where the patient is already engaged – so as to keep that engagement – they are then much more likely to stay engaged when other fctors are raised that they may not have thought of.
Sally,
You got it. I agree that there is a big opportunity for health coaches if done right. Thanks for your comments!
Steve Wilkins
The experience of having a physician that works well with a patient is a significant part of the healing process and is gratifying to both. Both participants must work toward this goal. Financial incentives and ego gratification of the doctor and cultural glorification of doctors learned by some patients can interfere with this endeavor. Open discussion of both parties’ responsibilities can help mitigate patient harm.