Everywhere you turn in the health care literature these days we are told how physicians need to do a better job getting patients engaged in their own health.
But is lack of patient engagement really the problem?
If Patients Are In Their Doctor’s Office They Are Already Engaged…
Each year, 80%+ of U.S. adults visit their doctor’s office at least once a year. The average number of physician visits for U.S. adults is 3 visit/year…double that if the person has multiple chronic conditions.
People don’t just magically “show up” in doctor’s offices. A doctor’s visit is the result of a process of cognition, research, evaluation and decision making culminating in the patient decision to been seen by a doctor.
The first decision a person has to makes is whether they need to be seen by a doctor. To help make this determination people might talk with family or friends. A recent Wolters Kluwer poll on Health found that 50%of people who go online for health information do so before seeing their doctor. The fact that only 75% of people with physical symptoms decide not to see a doctor is a testament to peoples’ ability to discern what needs to be seen by a doctor and what doesn’t.
Next people must pick up the phone and make the appointment. Then they must take time off and arrange to get to the appointment. Finally people must show up for their appointment and wait…often thinking about the questions they need to ask the doctor.
By the time a person gets up on the exam room table they have already:
1) Decided that then needed to see the doctor.
2) Decided to make and keep their doctor’s appointment despite the self-talk that we will get better on our own.
3) Decided upon a list of questions to discuss with the doctor.
Now what about this suggests that people in their doctor’s office are not engaged in their health?
The Problem Today Is Not A Lack A Patient Engagement…But Rather Physicians Whose Patient Communication Skills Are Not Very Engaging
Let’s assume for a moment that you agree with the premise that patients are engaged as described about. Now put yourself in the place of the typical patient and ask yourself how engaging it is when your doctor:
- Interrupts you as you are trying to “tell your story?”
- Asks your opinion as to what’s wrong or if you agree with their diagnosis
- Ignores what you have to say
- Avoids any discussion about your feelings
- Limits you to 1 question per visit
- Appears rushed
Chances are you wouldn’t feel this to be particularly engaging behavior any more than most people do. But then this is how the vast majority of physicians were taught how to talk to patients in medical school, e.g., where the physician’s focus was on the illness a person had…not the person with an illness.
So What’s The Solution?
The solution lies in teaching physicians new, patient-centered communication skills that invite and motivate patients into exam room conversations about their health. The benefits to physicians of becoming more patient-centered in how they talk to patients extends well beyond engaging patients. Patient-centered communication skills, considered the benchmark for effective patient communications, are also linked in the evidence to:
- Better patient health outcomes
- Improved safety and quality
- Reduced ER and hospital use
- Increased patient adherence
- Stronger physician-patient relationships
- Exceptional patient experiences
- Increased visit productivity
Check out Mind The Gap Communication Solution for more information on improving the patient-centered communication skills of physicians in your provider network
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.