When It Comes To Patient Engagement…It’s The Little Things That Count

I did a dumb thing a couple of weeks ago.   I fell off a ladder on to a cement floor and broke some ribs.

I went to the local ER, was x-rayed, and went home.   There’s nothing they do for broken ribs these days it seems.   The treating Physician’s Assistant told me she had notified my primary care doctor of my fall and resulting injuries.   Mind you this is the same primary care physician who was aware of my 3 recent retinal detachments, major surgeries (Vitrectomies), and prolonged recovery from these events.

It’s been a month since I feel off the ladder….and in all that time I haven’t heard a peep from my personal physician.  That bothers me.

It’s not like I had a problem that needed follow-up…but it would have been nice – perhaps even prudent – for his office to call and see how I was doing.   Why?  The fact that he didn’t call just reminds me that my physician really doesn’t think or care very much about me – as a patient or a person.   Either that or he has yet to read the ER report of my injury from 4 week ago.

In truth everyone I have spoken to about this has had a similar experience.  This is unfortunate for patients and the medical profession.   As patient’s we are continually reminded that physicians don’t have time for us or our problems.  We chide ourselves for not looking for a new doctor in the hope that things might be better.   For their part,  medical professionals meanwhile are clueless why their patients are not as engaged in their health or adherent as they should be.

Want to Engage Your Patients?  Act Like You Care

We all know primary care physicians are very busy and not properly reimbursed for all the work they do.  We also know you all had mothers that “taught you better.”  We all had those same mothers.  Mine used to tell us kids that you “catch more flies with honey than you do with vinegar.”

If you really want to blow the socks off even the most jaded of patients….call them up and ask them how they are doing.  Start with a phone call – it’s more personal than an e-mail.  Just tell the patient that you “know there not ever enough time during office visits to show you care…so when you had a free minute you wanted to remedy that.”

Start with your chronic and frail patients – one call is all you need.  Do this one simple  albeit time consumer thing and your outcomes ill improve, patient adherence will improve, patient satisfaction and loyalty will improve…and you will feel better about yourself.  Think of it as a long-term investment.

You need more proof?  Calculate the ROI of buying and installing an EMR system and hiring a care coordinator and then compare it to the cost of making a single phone call to your sickest patients.   When you compare the saving from the EMR and the cost of your time to make the phone calls….you will be amazed that you didn’t do it sooner!

This ain’t rocket science!  Go out now and make your Mamma proud!

That’s my opinion…what’s yours?

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


Stein, T., Nagy, V.T., Jacobs, L. (1998). Caring for Patients One Conversation at a Time : Permanente Journal, 2(4), 62-68.

19 responses to “When It Comes To Patient Engagement…It’s The Little Things That Count

  1. I am a health psychologist and the primary group of physicians I work with are OB-Gyn’s as my specialty is women’s reproductive health. Many of the physicians I work with, perhaps because they are already more emotionally attuned to their patient’s needs since they’re referring to me to see their patients for counseling, are very responsive. Either they or their staffs keep close tabs on expecting and new moms who are struggling emotionally. Like you say, it goes a long way in moms feeling cared for and complying with their physician’s request to seek emotional health care. As doctors, we must remember that we are caring for “people” who deserve to be treated with dignity, compassion and respect. Keep us the good work!

  2. Even though I present keynotes to healthcare professionals about the patient experience, I have left out this particular experience, which I share with you and others. I feel embarrassed. Needy. They don’t have the time and it’s not like there is any more they can do for me in a clinical sense. The confusion I feel is knowing that my relationship with my GP is a professional relationship that he is paid. He is not my “friend”. And “caring” isn’t a commodity. Yet I do expect him to care about me as a person whose health and well being is important to him, So, yeah, it would make a world of difference to get just the acknowledgment from my GP that he is aware of medical issues that he may not be directly involved in and that he is available should I need additional support.

  3. My primary “doctor is a Nurse Practioner I drive 30 minutes across town to see her why – A few years ago I was having a hard time with allergies resulting in a bad case of asthma. I was given a Flu shot, a shot for pneumonia and Rx. That night around 8 pm she called me to say that she had reviewed my history and since heart trouble ran in my family she was sending me for an electrocardiogram. You could have knocked me over with a feather. Not only that she had called – but that she read my history.
    I recommend her to everyone. She is the best healer I know.

  4. Thoelen Dominique

    Your posting is an interesting subject to me, a GP in Europe (Belgium). Problem is not only “time”, but also “money” (reimbursement) and “organisation”. Simply said : “we (GP’s) act when we are called”, we are “problemsolvers when a problem is presented”.

    So it’s not our “nature” to intervene or to contact our patients when we are not invited to do so. This attitude is working very well in acute care . It ‘s not working so well in chronic conditions and when we are delegating jobs to other institutes or to other disciplines. It demands a change of mind and maybe this will be more important to the quality of our future care and the efficiency of our primary care services . Maybe we should instead of “problemsolving care” rather move to our role in continuity of care, comprehensive care, quality of care, coordination of care …

    And when this should become a systemic change, so there is the problem of reimbursement (as katalysator of change of mind) and organisation of future care (lack of human resources and lack of budget).

    As a GP it’s interesting to me to read the comments about the importance of this subject to patients and other disciplines.

    Maybe it’s interesting to post this subject on the “Primary care Forum” where you’re also a member.

  5. Beth Neary, MD

    As a primary care doctor myself, I will comment on your post. If I read the ER report (which likely came by fax or even by email with another 50 or so reports), my assumption would be “this problem was handled at the ER and if there is a problem, the patient will call me”. Most times, the ER will have you make an appt for follow-up with your primary care doctor after an ER visit. In all honesty, it does not mean that your doctor does not care. The next time that I saw you for a visit, I would mention this and ask how you are doing. There is a reality here—that is, there is only so much time to handle the patients in the office, urgent phone calls, etc. If I was the patient as you were, I would not even begin to expect that my primary care doctor would call me for the situation that you describe. Certainly, there are many situations when I do make a follow-up call.

    • “I would not even begin to expect that my primary care doctor would call me for the situation that you describe.”

      I can appreciate that physicians have different expectations and sensibilities than patients. After all you understand and work with the role expectations of the patient-physician relationship every work day. Most patients at one time or another expect (always unvoiced) that their doctors will not only “provide care when they need it”…but they also expect that their cares.

      Think about it. If the vast majority of patients in fact find themselves settling for average “care and caring” from their physicians…imagine how easy it would be for the “simple act of caring” to become the next big disruptive innovation in health care.

      Thanks for your thoughts!

      Steve Wilkins

  6. If docs would only embrace technology, they could help their patient feel cared about – without the need for a phone call. I agree with Dr. Neary, time is a significant factor and docs can’t be calling everyone or every thing – and every patient has different expectations – docs have a life as well…howevemr, that being said, the use of email would alleviate so many people’s worries, placate so many needy patients, and answer questions of those PTs that really don’t need an OV (and to spend $30 or more for a copay, and taken time off work).

  7. I can understand the plight of the ignored or disenfranchised patient. I’ve been there – a lot. I can also understand the need to feel that our physicians care about us. I’ve changed my GP for this very reason. I have always felt, however, that the world works a little more as Dr. Neary has suggested in her post. If I have continuing concerns, I call my doctor. That is not to say that my doctor hasn’t called me. My long-time physician before I moved across state did that on a couple of occasions; however, he was following up with critical instructions after tests. I suppose I began to change my mind about this particular point when I read some statistics about the ratio of patients to physicians. It’s absolutely staggering! If they followed up with personal calls on multiple issues every day, they would never sleep. Honestly, I would rather have my doctor be sharp and at the top of their game when I arrive in their office. You said in your post, “It’s not like I had a problem that needed follow-up…but it would have been nice –” Yes, it would, but my best guess is that physicians have to make decisions all the time about whether to be nice or whether to be effective.That said, I do hope you’re feeling better now! Thanks for the blog.

    • Karen,

      Thanks for your thoughts! Yes I am feeling much better…thanks!.

      You are spot on with respect to the “effectiveness thing.” But if physicians really behaved towards patients (or their peers) based upon the behavior that was most efficacious..all physicians would be more empathetic, employ patient-centered communications techniques, would be adherent to recommended clinical guidelines, screen patients for depression, help patients top smoking, lose weight, and so on. So the question becomes one of physicians picking and choosing which efficacious intervention they want to employ and those they don’t.

      If in fact a study was done comparing the efficacy of e-mail versus person-to-person patient-physician communication it would be interesting to see which had the more long lasting impact.

      Steve Wilkins

  8. It is time for each of us to take on the responsibility of being in the “center” of our own health. The days where it was the doctors responsibility to reach out and give me a call just to make me feel good are gone, and by the way, those days where it was the doctors job to keep me healthy are why we as a culture are not living healthy, responsible lives… It was the doctors responsibility, not mine.

    Take responsibility for your own health and wellness instead of leaving it up to an overworked medical professional.

  9. Every primary care doc I know spends an hour or two a day reviewing ER notes, consultations, follow-ups and such from other physicians. This is something we do for free, and none of our much better paid colleagues is expected to do this.

    But that’s not enough for you. You demand that we then spend another hour doing phone calls and e-mails to follow-up on work that other MDs were paid very well for doing.

    Applying more pressure on the most over-worked and under-paid link in the health care chain isn’t going to fix anything.

    • Southern Doc,

      Who said life was fair. All of us are expected to do things we don’t get paid for or acknowledgement for. Fortunately for physicians, most patients have long ago given up any belief that their physicians truly Care about them (versus provide care to them). All I am suggesting is that if one wants bigger P4P incentive payments, higher satisfaction scores, and prosper under value-based care…you might want to remember how important the patient is to one’s revenue and livelihood.

      As usual thanks for your comments!

      Steve Wilkins

      • southern doc

        “All of us are expected to do things we don’t get paid for or acknowledgement for”

        Agree completely.

        For example. we USED to call all patients after ER visits, surgery, hospitalizations, etc. We had to eliminate that and give that time to dealing with pre-auths and pharmacy benefit plans.

        What you’ve identified is a problem, but it’s a system-wide problem that will only get worse as more and more administrative chores become the physician’s responsibility. Trying to find individuals to blame doesn’t get us anywhere.

  10. A few examples of how primary care is changing to better meet the needs of their patients
    1. Patient Centered Medical Home: Many health plans realize physicians need help to effectively coordinate care for their patients when they ‘don’t see them’. They are embedding Case Managers in their practice.
    2. I was teaching a class on Saturday in Ohio and learned that many primary care practices are working together and each taking a turn as a Hospitalists to care for their patients. They don’t like the traditional model of a general hospitalist taking care of their patients as they are out of the loop.

    3. Another Medical Home has a psychologist on the team and take patients to the psychologist right at the point of care when they realize the patient may benefit from a assessment. The psychologist shared that she gains trust from the patient as the MD referred them care is efficient as the assessment can be done, and treatment can begin vs. waiting weeks for an appointment.

    I agree with your post, but also see that the delivery system is changing…..and will be better…consumers can look for practices that have transformed to the medical home and have a team in place to meet their health and healthcare needs more efficiently and effective.

    • Anne,

      Thanks for insights into the changes you mentioned. I am particularly curious about the hospitalist modification you mentioned. At least in that instance the hospitalized patient might know the the treating physician’s name. It would be interesting to compare hospital readmission rates for CHF, etc. pre- and post introduction of hospitalists.

      As for PC<H in general, and case managers in particular, I am waiting to see some semblance of "patient-centeredness." PCMH 1.0 has been all about laying the technical and staffing infrastructure. Physicians no doubt still communicate with patients using the same physician-directed stale that they have always employed meaning that there is little room for the patient's perspective, which is key to delivering patient-centered care.

      I would argue that many of the changes going on…at least the way they are being implemented…are for the benefit of the care delivery system and not necessarily the patient.

      Thanks Ann for your comments!

      Steve Wilkins

  11. I just published 12 case studies about what matters to patients especially before scheduling an appointment. #1 piece of info was previous patient engagement & satisfaction. Great post!

    Here’s the link to the case studies: http://www.healthcaremarketingcoe.com/doctor_reputation_management/12_Case_Studies.php

  12. I’ve been with my internist for 8 years. He has a kind, friendly, and open manner, explains things well, encourages questions and input and I believe him to be a caring doctor. He helped me when my son passed away, by agreeing to spend an office visit going over the autopsy with me. He was extremely empathetic, allowed me to talk about it, and has always asked about my mood and depression since then. He encouraged me to get a therapist, and prescribed antidepressants for me. He has been spot on when zeroing in on some of my health problems, and identified a stomach problem that I had been havng prior to becoming his patient, as something different than what my other doctor treated it for.

    He sent me on to very good doctors who diagnosed it and then operated on it. I did not get a phone call or message from my internist after that surgery. Would I have liked that? Oh, sure… I would have loved it. But I didn’t even wonder about not hearing from him, and assumed that since he had handed me off, he’d see the reports and we might talk about it during the next visit. A few years later, my lab report came back with a low iron count, and he called me personally to explain what he saw, what it could possibly mean, and to ask me to come in for a retest.

    When it still came back even lower, he tested me for blood in the stool and then sent me on to a gastro guy, who found a bleeding ulcer. I had a follow up visit with my internist, who prescribed the medication for treating it. So, I didn’t need a call for this. Then, he checked out some shoulder pain I was having and indicated that it probably was not just “tendonitis,” as I thought. He said it seemed like it could be a torn rotator cuff, just due to the location. After seeing an ortho surgeon, I ended up having surgery for…. a torn rator cuff and bone spurs. He received reports on this, but I didn’t have a call from him. I didn’t expect it. When I fell 3 times within 18 months, ending up with black eyes, he ordered CT scans every time and he even questioned me, in a very gentle manner, as to whether someone might be hurting me at home. That’s not what was happening, but I did appreciate his concern, although I was a bit embarrassed. He told me that I could tell him anything, and I know that I can. He works with me about my blood pressure (high, but going down), my weight issues, and we talk about my evening wine drinking….. in a very, easygoing way, yet he lets me know what I need to do to cut back and how important it is. He found me to be very low in vitamin D a few years ago, and spent time educating me about the need for me to get my levels up, and he prescribed high doses to help.

    Recently, I suddenly became allergic to bees, got stung, and had a severe reaction, resulting in an ER visit, IV treatment, etc. My doctor was on vacation, but I emailed his office, and his nurse got the message to him. He had her call me to give me advice to see an allergist, and also to discuss one of my meds which could cause a stronger reaction to allergic reactions. He said we’d talk about it at my next visit. I was impressed that he addressed it during his vacation, and hoped it was just a brief moment and not an interruption. Yes, I would love to hear from my doctor personally when some of these things happen to me outside of his care. But, he probably sees between 20-30 patients most clinic days, and other days he is the medical director of his entire group’s ambulatory technology, working with a whole team several times a week. He’s been instrumental in bringing technology changes to their group, such as a portal for patient / doctor email communication. This portal has been a very easy way to ask questions about all kinds of things, and I always get an answer. If he’s out, the answer might be from his nurse or another doctor, but most often it is directly from him. This goes a long way to making me feel that he does care about everything about a patient.

    He is very forward thinking and spends a lot of time posting very interesting and educational things on Twitter. He’s also highly trained in Diabetes management, and hypertension. He is a strong family man with three young children, and a wife who is also an internist. I respect him greatly, and I would love to pick his brain and have more time with him just talking, or having him call me about health issues. But let’s be realistic. He needs and deserves a good quality of life. Of course it might only take five minutes to call me or email me just to check in with a “hope you’re doing well” type thing after a surgery, but what if he had to do that for an extra 10 people a week? or twenty? His precious time would be better spent goofing around with his kids, enjoying a drink on his patio, taking a walk, or eating lunch with his wife. I taught school for 20 years, and sometimes those phone calls to parents, meant to take about five minutes, ended up taking 15 or even 30 minutes. Those calls were sometimes the thing that kept me from time spent doing something else. As I often worked ten hour days, an extra fifteen or twenty minutes sometimes was the thing that I felt I could not do.

    As much as I would have liked to just call parents and say, “hey, your kid is great. There are not problems, but I just wanted to let you know that your kid is being very successful in my class, and I just enjoy him greatly.” But I just rarely had time for those kinds of calls. So, I would just like to say that I would welcome calls from my doctor for just “how are you doing?” but not at the expense of his health, happiness and stress level. I am actually really hoping that telemedicine comes to his office soon, and that it can help make office visits more convenient for both patients and doctors.

    His office is very efficient, with wait times being within ten or fifteen minutes, and the all of the staff are very pleasant and courteous. At my previous internist’s office, you never knew if you were going to get your head bitten off for asking how much longer it would be, when you’d already waited an hour or more. My doctor is very respectful of his patient’s time, and always apologizes if they run even twenty minutes behind, which to me is nothing. I have been grateful that my doctor really listens, and is quick to send me to specialists when needed. I also need to mention that every doctor he has sent me to has been excellent also, and I have been very happy with the results. I have an easy rapport with my doctor, and we frequently talk about family. We have also talked about all the new technology coming to medicine.

    I find it sad that some doctors might convey the feeling that they only care about that part of a patient’s health that they are paid for managing. I definitely do not feel this from my doctor, even though I don’t get calls from him when I’ve had issues outside of his expertise

  13. “Those calls were sometimes the thing that kept me from time spent doing something else.”

    So well said. Great post.

    People need to realize that continually dumping more expectations, responsibilities, demands on the plates of teachers, social workers, primary care docs, is a recipe for disaster and is not the way to solve society’s problems.

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