Patient Engagement From The Patient’s Perspective

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I apologize for my absence over the past month.  I was side-lined with two detached retinas in December both of which required major eye surgeries and downtime.   

For health care professionals, patient engagement is the holy grail of health care.  It is the key to patient adherence – a prerequisite to achieving better outcomes, fewer ER visits and hospitalizations and more satisfied patients.  It is easy to recognize an engaged patient – they do what their health care providers recommends…what their health care team knows what is right for them.

But Doesn’t Engagement Depend Upon Your Perspective?

In a earlier life I spent a lot of time looking at health behavior.  Among the many things I learned were the following:

  • We all define health within the context of our own lives and in our own way
  • We all are satisfied with different levels of health

Providers and Patients Often See Things Very Differently

Admittedly there are patterns of health behavior or archetypes which can be used to segment health populations.  One such archetype is characterized as 1) placing a high priority on achieving a high level of personal health, 2) being very proactive in terms of achieving and maintaining their above average health, and 3) having a moderate to high distrust of the medical professionals.

Not surprisingly, people who shared this pattern of health-related thinking demonstrated lower levels of physician visits, fewer hospital and ER visits, lower health care costs.  They get sick and develop chronic conditions like everyone else, but because of their health proactivity , they tended to the healthiest relative to all other patterns of health thinking and behavior.   Because of their trust issues with their providers and willingness to experiment with new health alternatives, these patients are “mavericks” doing their own thing when it came to self care (when sick) and staying healthy .  In other words they may not be the most compliant of patients from the providers’ perspective…and therefore would be considered “unengaged” in their health care.  

This post is the 1st 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 vs, Physician Engagement – Which Comes First?

People Can Be Engaged In Their Own Health And Never See A Doctor, Visit A Hospital, Or Take A Rx Medication

If you were to tell these independently healthy folks that they were “not engaged” in their own health they would likely scoff and say “what do you expect…the health care industry doesn’t take the time to understand the patient’s perspective.”  In truth, aren’t people like this doing a better job than the health industry when it comes to “engagement” and staying healthy?

The point is that we as health care professionals need to start looking at things like the definition of health, health goals, compliance, and outcomes from the patient’s perspective.  We need to incorporate the patient’s perspective into outcome and satisfaction measures.   Only then do we have the right to “judge” whether a person (aka patient) is engaged, activated, or empowered.   Once the health industry gets past this paternalistic, “we know better than you do” attitude then we can expect to see real change in health behavior and outcomes.

That’s what I think.  What’s your opinion?

8 Comments

  1. Ken Raymond says:

    Let’s acknowledge that the physician’s relationship and care of patients is undergoing a seismic shift with the patient’s access to information, perhaps TMI, with no medical perspective to appropriately filter same…nonetheless, it is the dynamic. The patient is coming to understand that, in many cases, the practice of medicine is not an exact science so might the profession consider the need to develop better listening and negotiating skills to assist patients in arriving at medical decisions that both the physician and patient can embrace?

  2. JD Wright MD says:

    Stephen:
    I’m glad you’re back and hope your eye surgeries went well. And again, thanks for continuing this conversation about patient engagement and how this underpins the effectiveness of the entire healthcare system.
    You again bring up some very important points about the doctor-patient relationship, which, as I’ve said before, is far from 50-50. (That would be an interesting survey: to ask patients what they feel is the balance of power in their relationship with their doctor, 40-60, 25-75, 10-90, etc.)
    Your comment about “engaged” patients is very true. Every doctor likes to care for patients like this: compliant, agreeable, full of gratitude and praise for their physician, etc. These patients don’t ask a lot of questions, and when they do they are not very demanding. If we could stratify patients from “engaged” on one end to “mavericks” on the other, then the patients closer to the maverick end are a lot more challenging to deal with. They tend not to take the doctor’s word for everything. They may challenge or disagree with information given by their doc or his/her advice.
    I would disagree with you a bit when you say “we all aspire to different levels of health.” I think everyone wants to be healthy, and I believe that most people would define that similarly: free of disease & illness, not limited in their pursuits by physical or mental infirmities, etc. Where people do differ greatly is in their approach to achieve or maintain health, and how to negotiate the trade-off’s in doing that, e.g., the personal satisfaction in smoking vs promised health benefits of quitting (improved lung & heart health, less chance of developing cancer), or the pleasure of eating an ad lib diet vs health benefits of eating a more restricted diet (weight loss, lower BP, lower cholesterol, etc).
    One of the things I have tried to do is represent myself to patients as an advisor. I have a lot of training and experience which are crucial in my ability to give people good health advice. But if patients elect not to take my advice, or parts of it, I have to respect that it’s their decision. I may vigorously try to convince them to do this or not do that and point out the error(s) of their ways, but at the end of the day it’s their health and their decision.

    • ed howard at ehoward@bmwofminn.com says:

      Dr Wright. I agree wholeheartedly that Doctors need to listen,listen, and listen somemore.. as an example, I have been having serious skin reactions, went to my personal physician, dermatologist, dentist for gum problems i felt were related, and periodontist .. not one of them asked about my medications i was taking, and when i asked if any of all these symptoms could be related to my medications, they said they didnt think so. many differnet diagnosis’ . just stuff to try and cover up the symptoms,, i finally took it upon myself to discontinue one of these meds because of what i read on the interent as my symptoms could be life threatening side affects of the medication.. I have lost all faith in the medical profession, as not one of them really cared about my problem which was scaring me to death, or wanted to take the time over there 5 minute appointment to try and figure out what was going on.. I am not a Dr., but i feel i am a lot smarter about my own body then any of the Drs. i talked to,, and these Doctors are all rated very highly in their fields.. as you can tell, I am totally frustrated and worried, and sure wish I could find a Doctor who would sit down and analyze what is happening, and come up with a good approach…thanks for letting me vent…Ed Howard.

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  5. Peter Yetti says:

    The hope for a more engaged patient will become a reality as the generation that has grown up expecting immediate access to information begins to demand that same access when it comes to their health care. Prior generations dealt with both structural and cultural obstacles when dealing with the medical professionals (paper files vs EMR; “paternalistic communication” vs communal). These obstacles are slowly being taken down and will soon be a relic of a once out-dated health care system.
    The concern, however, I believe, is that with this engagement will come increased autonomy and an increased desire to reject findings from a medical professional and ultimately self-diagnose. Patients may attempt to manufacture the diagnosis they prefer. Without question patient engagement is an important goal, but it should coincide with educating patients on what their expectations should be, and how best to reconcile their own wants and needs with the results of medical professionals.

  6. My feeling about patient engagement is relatively simple. There is not enough investment in first point of contact. As someone running a healthcare company, we have managed to double attendance and participation, improved outcomes massively and had incredible patient feedback all stemming from this initial point.

    The first point of contact is usually not a clinician, but an administrator. My now personal hate (much like Mitchell and Webbs sketch of the office manager who hates mispronunciation) is for people who say ‘Doctor will see you now’ instead of “the doctor’ or Doctor smith. Thats a side issue but I need to get it off my chest.

    However if the first point of contact is an administrator, what if they had been trained in counselling skills and what is known as creative listening, what if they had been sent on courses to understand some of the medical problems the patients were dealing with. What if they had telephone training or speech training so they spoke clearly. These are all portable skills which most employees are happy to take and get something out of.

    However many clinicians find this difficult, counselling skills are often not looked at kindly and the idea of creative listening is seen as wishy washy airy fairy rubbish by a fair few clinicians I know. Yet these very things have led to our success. An admin receptionist who can talk the language of your care, who offers unconditional regard, who speaks clearly and listens carefully. Patients love it. They respond positively and engage more fully in their care.

    Admittedly many of the people we see have not had a high regard for their health, and part of our job is to change their thinking , outlook and in some cases lifestyle. Engaging them in this way at the first point of contact starts that change from the beginning.

    If we expect more from our patients we need to expect more from those who work in healthcare, not just clinicians (your next article) but everyone from the receptionist to the cleaner. Talking of which I visited to a care home recently where the cleaners are encouraged to meet and greet, rather than just keep their heads down and mop.

  7. [...] Engaged patients are compliant, priortize self-help, proactive to maintain health, modest distrust of health professionals. Blog from Stephen Wilkins [...]

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