Why Would Geisinger Health Take A Paternalist Versus A Patient-Centered Approach To Patient Engagement?


I am always a bit ambivalent about coming off as “too preachy.”    I am at an even greater loss as to when it’s OK to find fault with what others say or do when it comes to patient communications or patient engagement.

But sometimes I just have got to say something…and this is one of those times.do this

The setting was a presentation earlier this week at HIMSS 2014. The presenter was Chanin Wendling, the Director of eHealth at Geisinger Health System.  Channing was talking about Geisinger’s often-cited HIT-driven patient engagement efforts which includes their patient portal, health apps and a recent foray into “Open Notes.”

What struck me was Chanin’s description of the philosophical approach and communication style employed by Geisinger Health in the course of developing content for these engagement tools.

Here’s what she said.

“We tend to think in a paternalistic way: this is what the patient needs, versus thinking ‘What will work best for the patient?’ and ‘How will the patient relate to whatever we’re prescribing?’ And that’s extremely important because at the end of the day, if you can’t get the patient to help, if they don’t take their meds, if they don’t lose the weight, if they don’t do their exercises, there’s nothing you as a clinician can do. You need the patient to help you.”

Here are two things that jumped out at me from Chanin’s comments;

1. Geinsinger’s patient communication style is paternalistic and physician-directed…meaning that it is the direct opposite of a patient-centered philosophical approach and communication style.  You will recall that an increased focus on “patient-centeredness” was called for in the IOM”s Crossing the Quality Chasm.

A patient-centered communication style begins with an understanding of the very things Chanin says Geisinger ignores – what will work best for the patient and how patients will relate to a proposed intervention.

The evidence is clear that a patient-centered approach…not a paternalistic, “we know best” approach…is linked to increased patient engagement, better outcomes, more adherent patients, lower utilization and better patient experiences.

patient communication style continuum(1)2. Geisinger Health is not alone in its belief that patients are inherently unengaged in the health, e.g., patients won’t help clinicians unless told by clinicians what they need to do.  This same “we know best” physician-directed patient communication style is what most physicians learned years ago in medical school.  So it is not surprising that this same style of communications has it has found its way into other forms of communications like patient portals and health apps. But come on…this Geisinger Health we are talking about and they really should know better.

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After all,  82% of U.S. adults visit their doctor at least once a year…the average being 3 visits/year…and double that for people with chronic conditions. Why? Because “they” think it’s the right thing to do.  And yet Geisinger Health thinks that patients are “not willing to help” providers do their job?  Are you kidding me?

The problem today is not that patients are unengaged…but rather that many providers aren’t very engaging.   Sure 50% of patients are non-adherent…but 20% of patient non-adherence has been attributed to poor physician communications, e.g., paternalistic, physician-directed communications.  Sure less than 10% of patients visit the average patient portal in a year…but when portal contents and functionality treats one like an uncooperative child why would anyone expect a higher level of adoption?

The Take Away?

Unless and until provider organizations like Geisinger philosophically come to grips with the fact that patients, aka people, are often already engaged and knowledgeable, albeit in ways that are different from how providers expect…nothing is going to change.

The solution? Become more patient-centered in the way you think about, interact with and communicate with patients.

That’s my opinion. What’s yours?


1 Comment

  1. Gillian Cappiello says:

    I completely agree Stephen. I can’t quite see how different  ”What the patient needs”  is from ‘What will work best for the patient?’

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