The Secret to Patient Engagement – More engaging physicians

If you ask people involved in Patient Engagement about how hands-on they are in their own health, the most common reply you will get would be something along the lines of,  “I try to take care of myself by doing X or Y or Z.”

About 82% of US adults have a regular doctor whom they visit at least once a year with the average number of visits being 3 per year, which, in fact, is double the number of visits made by people with chronic conditions.

Obviously, one would think that this level of patient engagement would be immensely beneficial to physicians, administrators, health IT vendors and others involved. But that wouldn’t be correct. Let us see why.

Physicians, administrators, health IT vendors, etc. each, have their own definition of what patient engagement is. Let us see their definitions and how they measure patient engagement.

1.   Physicians/Provider definition of patient engagement:

Maintaining appointments, even though it might be about 6-7 appointments annually, along with abundant self-care, would not count as patient engagement from the physicians’ perspective. Most patients do not do as they are told by their physicians – they are often non-compliant.

As numerous physicians equate patient engagement with patient compliance, the high non-compliance rates (30%-70%) that are seen these days suggest that a large number of patients are far from engaged. What the clinicians fail to realize is that up to 20% of non-compliance is a direct result of poor physician-patient communication and not lack of engagement.

2.   Health IT Professionals and Vendors:

Health IT professionals neither consider “showing up” nor the level of compliance of the patient when it comes to defining or measuring patient engagement. The HIMSS (NeHC) Patient Engagement Framework would have you believe that the true patient engagement is all about the use of health information technology and the achievement of Stage 2 Meaningful Use, which means, as long as the patients use the right health IT tools, they are considered engaged.

What Health IT industry often overlooks is the fact that 85% of patient prefer to meet their doctor face-to-face when they feel the need. They are reluctant to let technology get in between them and their doctor.

The challenge however, the physicians and health IT professionals face, is not how to engage more patients, but actually, it’s about how to be more engaging to the majority of the patients who have already been engaged.

The reality is that health care is about everyone but the patient. Most physicians still relate to their patients using a peculiar communication style where they act as the clinicians knows best, does the most talking and makes almost all decisions for the patient. Patients are encouraged to be passive and compliant rather than being engaged.

Health IT treats patients as unwise and unneeded when it comes to engagement. They ignore the fact that 85% of adults want to be able to interact with their physician face-to-face whenever they want, regardless of their showing willingness to use secure email, patient portals or any other such technology. People are not unwise. They realize that Health IT wants to put technology between themselves and their doctor. A number of patients have stated that laptops and computers in the exam room interfere with the doctor-patient relationship. This is clearly not serving patient engagement.

The only certain technique to improve patient engagement is to be more engaging to the patient. Which means being more patient-centered. The patient-centered attitude should reflect in the things being done for the patient, the way physicians talk and listen to them, the way products and services are designed, and how patient engagement is assessed.

This includes obtaining the patient’s story, paying attention to their health beliefs, fears and concerns, comprehending their health information needs and interests, understanding their previous health experiences, and so on.

The patient has the major stake in their own health. This should never be forgotten. Besides, it’s not like they don’t have brains.

The Ten Commandments Of Patient Engagement In The Doctor’s Office

Here is a list of things that physicians, hospitals, along with concerned stake holder partners, etc. need to do to increase patient engagement:

  1. Regardless of how busy you are, act like you are glad to see them (patients).
  2. Say something to hint that you actually remember who they are – this one is crucial.
  3. Enquire about their health after the last appointment and the reason for them coming today. Remember what they say and come back to it later.
  4. Seek for the patient’s idea related to the reason behind the complaints and ask them what they would like you to do for them.
  5. When the patient describes their problem, avoid interrupting them. Ask questions that would further clarify the problem. Show interest in them. They need to be invited to speak up.
  6. Let the patient know your recommendations about the tests, treatments and new medications. Give the reason behind your recommendation. Make sure to check if the patient is okay with it. If not, ask why.
  7. Pay attention to the cues initiated by the patient. Oft times, they are a call for help.
  8. 8.   Show empathy towards them and try to support the patient as best possible.
  9. Try to figure out their health goals and find out the steps they believe can be taken in order to achieve them.
  10. 10.  Suggest ways by which you and your team can support the patients’ long-term care plans.

Most physicians do not face the challenge of “How to engage patients?” since most patients are already engaged to the extent that:

  • They bothered to call your staff and made the appointment (which seldom is a pleasant experience).
  • Took time off work to come to your office.
  • Waited a while before seeing you.
  • Thought about what they wanted to talk to you and how you are too busy to listen.

Rather, the challenge for the providers is “How to be engaging to the patients?” Healthcare always has been the intensely personal and social interaction between human beings.

Health IT professionals will have you believe that EMRs, web portals and smart phone health apps are the best way to engage patients. Which they are not. People would be more engaged in the care only if the providers were more engaging.

Empowering patients to ensure their physician does not miss-out on opportunities to be a better provider

It is observed that on a normal day in the office, the average physician misses an ample of opportunities to engage with their patients. The reason behind this being their busy schedules. Research indicates that this happens because physicians do not have the proper patient-centered communication skills and awareness.

On a typical visit, patients provide their physicians with a number of verbal and non-verbal cues, indicating their thoughts and feelings. This is done to pose a question or just to show concern. The value of the cue is directly dependent on the physician understanding it.

Let’s break down a typical day in the office to better analyze the opportunities involved. On an average, a physician receives 3-4 Patient complaints, 2-3 requests and there are around 4-5 patient expectations.   Add them together and we have 9-12 opportunities, per visit. This is a substantial amount. Hence, it is of utmost importance that attention needs to be paid to those cues.

The cues may be apparent; like a patient complaining of depression, but more often, those cues are not clearly stated and the doctor needs to observe the patient’s body language, facial expressions, etc. to get the hint. Regardless of how a patient expresses them, these cues are opportunities to engage the patient.

Let us take an example to understand this better. Following is a brief conversation about the patient’s knee, and there are 4 cues that the patient expressed verbally.

Doctor: So, how is your exercise regimen since your last visit?

Patient: I’ve haven’t been feeling so great ever since I slipped on the ice and my knee hasn’t been as cooperative. I’ve been missing the exercise.

Doctor: How about the diet? Are you still sticking to it?

Patient: Yes, but…

Doctor: Well, now that the weather is warmer, you could get back to the jogging that we talked about before.

Patient: How about doing an MRI of the knee to check if I have torn something. A similar thing happened to my friend and she got an MRI. Turns out, she had torn her cartilage.

Doctor: If your knee continues to bother you after a month, come and see me.

The 4 cues actually represent 5 opportunities for the doctor. Those opportunities could be utilized to:

1.   Demonstrate that the doctor was paying attention and listening to the patient.

2.   Show comprehension of the patient’s expectations

3.   Relate and empathize with the patient.

4.   Explain why MRI isn’t a necessary procedure at this point of time.

5.   To integrate a diagnosis and a treatment plan in a way that the patient can buy into it.

The reason for a potential “fall-out” due to the response of the doctor to those cues would be:

·         Feeling of mistrust

·         Feeling that the concerns were dismissed easily

·         Feeling that the whole visit was a waste of time

·         Problem not resolved

Long-term potential outcomes might include:

·         Patient acting against the doctor which could cause the problem to worsen.

·         Dissatisfaction

·         Patient doesn’t share potentially relevant health information in future visits.

·         Patient decides to visit the ER instead of seeing the physician

Let’s estimate that the average patient visit generates around 10 such cues, which is a conservative number. If the physician identifies and addresses 50% of those cues, it would leave 5 missed opportunities per visit. This analysis would add up to a 110 missed opportunities on a typical business day. Which makes 440 missed opportunities a week and a staggering 22,880 opportunities a year for just one physician.

Think about the impact the physicians in your provider network could make if they were made aware about some basic communication skills which would enable them to be mindful of, acknowledge and properly respond to these cues in a way that the patient would appreciate.   Investing in improving these skills would no doubt have a significant impact.