Engage Your Patients And Members Where They Are…Not Where You Wish They Were

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Not long ago, Lloyd Dean, president and CEO of the San Francisco-based health care-system Dignity Health announced the Dignity Health and Box Patient Education App Challenge. In the course of the announcement, Dean is quoted as saying:

“We recognize the immense potential that (health information) technology has to enhance our patients’ care and overall experience.”

Dean’s use of the term “immense potential” with respect to patient-facing technologies like health apps and patient portals got me thinking.  Immense potential compared to what? Your patients and members are in your doctor’s offices not on your patient portals or using a health app!

With all the hype in the health press about the patient engagement potential of patient-facing health information technologies, one could be forgiven for thinking that HIT is the best if not only path to patient engagement.

But in fact there is another way.  Another more immediate, less costly and proven way.  And its potential to engage patients, enhance care and improve patient experiences dwarfs the “immense potential” of patient-facing HIT by comparison.

PC Communications vs HIT

Rediscovering the Power of Physician-Patient Exam Room Conversations

Here’s what I mean.  The average office-based physician engages in some 4,224 face-to-face visit-related conversations with patients each year.  Depending upon their communication skills, each of these conversations represents an opportunity for physicians to engage patients, enhance care and improve patient experiences.

In the case of Dignity Health’s 11,000 physicians, assuming they see an average of 20 patients/day/physician, this comes out to:

220,000 patient visit per day , 880,000 patient visits per week  45.7 million patient visits per year

Now factor in the 3-4 complaints each patient brings to the visit along with a myriad of beliefs, fears and expectations for service (tests, referrals, new medications, and so on).   I hope you are starting to realize that each patient visit is pregnant with opportunities for clinicians – your clinicians – to engage, empower and excite patients…. sometimes by doing nothing more than listening to what the patient wants to say.   Remember these are real opportunities that exist in the here and now…not some promise or dream of possibilities to come.

3-4 Complaints  +  2-3 Requests  +  4-5 Expectations  =  Lots Of Opportunities To Engage Patients

At this point you might be thinking that your physicians are already leveraging these exam room opportunities to build your organization’s brand, to refer patients to your specialists and ancillary services, and to direct patients to health information on your their/your patient portal.   You would probably be wrong.   Not because of the limited time available during the office visit…but rather because many physicians have never been trained or provided with the communications tools needed to recognize or facilitate these kinds of opportunities.   But that is the topic for a separate post.

Could Your Patient Communication Skills Use A Tune Up?  Find Out.  Sign Up For the Adopt One! Challenge. 

It’s Free For  Qualifying Physicians

The Patient-Facing HIT Opportunity

Now consider the opportunities in Lloyd Dean’s brave new world…a vision shared by HIT professionals health developers, vendors and their respective professional organizations.

Staying with the Dignity Health example, let’s assume that each of Dignity Health’s 11,000 doctors have patient panels of 2,300 adults and that 10% of these people use their respective patient portals or smart health apps 5 times per year (a generous assumption).  This comes out to approximately 12.6 million opportunities for Dignity to engage, empower and excite patients/consumers per year.

It’s doubtful that the opportunities for meaningful engagement afforded by a patient portal or health app compare qualitatively to the opportunities possible with a face-to-face physician visit.  Being able to check one’s lab tests, schedule an appointment, or refill a prescription while convenient are do not afford the same therapeutic benefits of a listening ear or the touch of a clinician’s hand.

The Take Away

The real “immense opportunity” for engaging patients, enhancing patient care and improving patient experiences lies behind the closed exam room doors of physicians’ offices.  That is the most frequent point of contact health care consumers have with the health care system.  It is also where truly meaningful patient engagement and memorable patient experience take place.

Engaging patients, enhancing care and improving patient experiences is not an either or choice between more health IT or better physician-patient communications. Providers will need both in the long run. HIT will enable clinicians with good patient communication skills to touch more patients and get more done.  Physicians in turn will recommend that patients go to their patient portals and smart apps for health information.

Imagine the ROI that organizations like Dignity Health’s could realize from their investments in patient portals and health apps if all 45.7 million annual patient visits were given a tailored information therapy prescription directing them to one or the other or both.

Now that is what I call IMMENSE POTENTIAL!

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

Helping physicians, hospitals and health plans do a better job of engaging patients, enhancing patient care and improving patient experiences in the exam room is the goal of the Adopt One! Challenge.  The Challenge is a great way for physicians to get a comprehensive baseline assessment of their patient communication skills, find out how their communication skills compare to best practices, and get access to online skills development tools.

Be sure to sign up for the Adopt One! Challenge Newsletter for more information.   Health plans and hospitals are invited to sponsor the Adopt One! Challenge for physicians in their provider network, including PCMHs and ACOs.

Could Your Patient Communication Skills Use A Tune Up?  Find Out.  Sign Up For the Adopt One! Challenge. 

It’s Free For  Qualifying Physicians

The Myth Of Patient-Centered Care

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I can’t think of any strategic initiative in recent time with more potential to engage and active patients, improve patient health outcomes and enhance patient experiences than the call by the Institute of Medicine in Crossing the Quality Chasm for providers to become more patient-centered.  Specifically, more patient-centered in the way they communicate with patients.

Having spent years working in the field, I am continually amazed at the rich body of evidence documenting the wide range of strategic benefits of engaging patients in conversations about their health goals, beliefs, motivations and expectations.   I am also amazed at how slow health plans, hospitals systems and the like have been to leverage the benefits of patient-centered communications within their provider networks.

A 2011 article in BMJ’s journal Quality and Safety highlight the present state of affairs with respect to patient-centered communications in the U.S.

The study looked at how often physicians employed the most essential and defining patient-centered communication skill – asking patients about what they expected from their health encounter.   In the case of the study, asking patients what they expected from a required hospital stay…although the finding could just as easily come from a study of physician office visits.

Why Is Understanding The Patient’s Expectations Important?

The basic premise of patient-centered care is that, where practicable, the clinician should honor the patient’s beliefs, motivations fears and expectations in the course of treating them.   Obviously before you can “honor” the patient’s “perspective” you first need to understand what they are. The clinician needs to ask the patient.

Could Your Patient Communication Skills Use A Tune Up?  Find Out.  Sign Up For the Adopt One! Challenge. 

It’s Free For  Qualifying Physicians

And there’s the rub.

Turns out that only 16% of physicians in the study (residents and attending physicians) admitted to routinely asking their patients about their health care-related expectations.

Research has shown that patients typically bring a set of expectations to health encounters. Some of these expectations may be explicitly verbalized by the patient by many are not.   They have to be solicited by the clinician.   Absent asking the patient, studies show that clinicians tend to underestimate and not recognize the patient’s perspective resulting in:

  • unmet expectations
  • poor satisfaction
  • low clinical guideline adherence
  • poor overall health outcomes

 

Patient Expectations

 

Clinician Barriers To Soliciting The Patient’s Perspective?

According to the physicians, failure to inquire about the patient’s expectations had little to do with a perceived lack of importance. Most physicians in a 2011 study believed that it was not only “important to understand their patient’s expectations” (89.4%) but that such expectations should be “responded to in a structured way” (88.5%) and “documented in the patient’s record” (67%).
Nor was lack of time or reimbursement cited a reason why they neglected to ask patients about their expectations.

The number one reason cited by physicians for not asking patients about their visit expectations was the lack of communication skills and know how.   They weren’t trained to ask patient questions like this.   This response is not surprising given that most physicians today employ the same physician-directed communication skills they learned in medical school.

The Take Away?

Findings from BJM Quality and Safety article, and other like it, suggest that health care providers today are no more patient-centered in the way they communicate with patients than they were 30 years ago when research into the dynamics of physician-patient communication first began.

This is unfortunate for patients, providers and payers. It unfortunate for patients in that they are not getting the quality of care that they expect and deserve.  It is unfortunate for providers in that they are not doing right by patients or themselves from the stand point of outcomes and satisfying, patient experiences.  It’s unfortunate for payers in that they are not getting full value for their health care expenditures.

The Solution?

Health plans, hospital systems, IPA, ACOs and the like need to invest some time and money in helping physicians improve their patient-centered communication skills.

Helping raise awareness of the state of physician-patient communications in the U.S. is why I have taken the lead in bringing together some of the leading authorities in the physician-patient communication filed to organize the Adopt One! Challenge.
Adopt One! challenges physicians across the country to take the first step by committing to adopt one new patient-centered communication skill in 2014.

As part of the Challenge, physicians will receive a baseline assessment of their patient communication skills, a comparison of their skills against best communication practices and unlimited access to the tools needed to help develop their new skill. Best of we are doing it for free for qualifying physicians.

For more information on the Adopt One! Challenge go to www.adoptonechallenge.com

Could Your Patient Communication Skills Use A Tune Up?  Find Out.  Sign Up For the Adopt One! Challenge. 

It’s Free For  Qualifying Physicians

Sources

Rozenblum, R. et al. Uncovering the blind spot of patient satisfaction: an international survey. BMJ Quality and Safety. 2011;20:959e965.

Bell RA, Kravitz RL, Thom D, et al. Unmet expectations for care and the patient-physician relationship. Journal of General Internal Medicine. 2002; 17:817e24

Death By A Thousand Cuts – Physicians’ Surprising Response To My Wife’s Lung Cancer Recurrence

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This is a true story….

My wife was about to celebrate her 10th anniversary as a Stage IV Non-Small Cell Lung Cancer survivor (a pretty remarkable feat) when it happened.

It started out as a cough.  We had just returned from a family trip and assumed she had picked up a “bug” from one of the boys. It also “lit up” on her semiannual PET/CT scan down at MD Anderson as small dark masses where there weren’t supposed to be any. We all hoped the cough and the PET/Ct results was the result of a cold or allergy….it had happened before. Her medical oncologist, one of the top thoracic oncologists in the world, doubted a recurrence after 10 years.  But if it was a recurrence, he told us he would put my wife back on Tarceva, the oral chemo that had worked so well for her before.

But we were all wrong. Her lung cancer was back and appeared to have spread.  The cough escalated into a 24/7 serious hack-a-thon.  She couldn’t finish a sentence without coughing.  We avoided being around other people as the coughing got worse. My wife didn’t want “bother” people.  Nor did we want our family and friends to get the wrong impression….that my wife was dying. She had beaten the odds once and she would do it again we told ourselves.  Turns out we were the only ones that believed it.

Within the space of 2 months, my wife saw a local pulmonologist (we live in Northern California not Houston, Texas where MD Anderson is) to rule out any other causes for the cough.  She also kept two long-scheduled appointments with an endocrinologist and a cardiologist for issues unrelated to the cough or cancer.

That’s When I Noticed It – Every Physician My Wife Saw Acted As If She Would Be Dead Soon

To be sure none of my wife’s physicians ever said she was dying. But knowing something about the nuances of how physicians “communicate” with patients I could tell that’s what they were thinking.  After attending every one of her doctor’s appointments over the last 10 years you recognize the tell tale signs.   Neither the endocrinologist or cardiologist were familiar with my wife or her condition as these were our first visit to both.  But they clearly could not get past her coughing.  They politely cut short the initial appointment and told my wife to contact them after the lung cancer had been dealt with.  You have bigger problems than a thyroid nodule or a rapid heartbeat they told us.

Mind you my wife was concerned enough (let’s say she was engaged) about her thyroid nodule and heart health that she 1) made the appointment to be seen and 2) actually kept the appointment because she/we believed that she would be around long enough to have to deal with these problems sometime.

The pulmonologist, after ruling out allergies or infectious disease as the cause of my wife’s cough, threw up his hands in apparent defeat and said “your cancer’s back and there’s nothing more I can do for you. “ He referred us to a local a local thoracic surgeon in order to get her cancer re-biopsied before starting chemo.

The thoracic surgeon, like the other doctors, couldn’t deal with my wife’s coughing and shortness of breath which was pretty bad by now.  Rather than come up with a definitive plan of action regarding the biopsy, the surgeon hemmed and hawed about the different approaches to doing the lung biopsy – one more invasive than the other.  The surgeon gave me the distinct impression that the biopsy in the long run wouldn’t matter given the apparent seriousness of my wife’s condition.  He promised to discuss the biopsy options with my wife’s oncologist the next day and call us with the “game plan.”  The doctor never called us back.

By this time it was 5:00 pm on a Friday afternoon.  We felt we had already wasted too much time between the pulmonologist and the thoracic surgeon and my wife started her oral chemo at 5:01 pm.  We immediately felt better because at least we were finally doing something positive to address my wife’s problem.  Anything is preferable to watching sympathetic physicians, nurses, office staff, radiology techs, etc.  shake their heads saying to themselves “poor woman” doesn’t have long to live.

Post Script

Within 10 days of starting her oral chemo, my wife’s cough and shortness of breath completely disappeared.  After 2 months of being on Tarceva the first follow up the first PET/CT scan revealed what the radiologists called a significant response to the treatment.

Not bad for someone whom so many clinicians had written off!

The Take Away

Physicians need to be aware of the fact that they both bring pre-existing attitudes and biases to the office visit…and check them at the door.  These attitudes and beliefs color the decisions clinicians make.  The extent to which clinicians inform patients of all their diagnosis and treatment options, engage patients in shared decision making, or decisions as to how aggressively treat the patient’s condition are all influenced by physician’s beliefs and attitudes.

Lung cancer that presents as a bad cough is like a red flag to a bull. It invokes a whole set of assumptions about 1) how the person got the disease (you must have been a smoker) and 2) the person’s odds of survival – slim to none.

You have to wonder how many people’s lives are cut short or whose care is not what it should be simply because their doctor jumped to the wrong conclusions.

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

Do You Really Believe That 41% Of People Would Switch Physicians To Gain Online Access To Their EMR?

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I love survey data as much as the next person. But some of the survey data finding its way into the health care press these days is pure baloney…which is good if you like baloney.

Such was the case with the finding from an Accenture study which was making the rounds of the Health Information Technology (HIT) Journals, HIT Blogs and Twitter feeds during National Health IT Week. You will no doubt recall the headlines which proclaimed that “41% of U.S. consumers would be willing to switch physicians to gain online access to their own EMRs.”

Upon first glance, the question of “would you be willing to switch physicians” to accomplish a social good (access to your electronic medical records) seems reasonable enough. It’s one of those questions that most of us would be inclined to agree with. It’s kind of like asking people if they would be willing to pay lower taxes or pay less to fill up your car’s gas tank. Of course we will say yes.

In the Accenture study literally everyone did! Remember 36% of respondents said they already had full access to their EMR (whatever full access means), 27% said they had limited EMR access and 37% said they did not yet have any EMR access. So if 41% said they would switch physicians to get EMR access we are left to conclude that all 100% of those without EMR access would switch…plus 4% of those who already had EMR access would also switch doctors presumably because they wanted more EMR access.

At face value, this Accenture data does not hold water…and here are a couple of reasons why.

  • 79% of people (patients) are already very satisfied with their personal physician (patients who rated their physician 9-10 on the 10 point 2012 CHAPS survey released recently by AHRQ. Very satisfied patients are not likely to switch physicians unless they have a darn good reason and access to Health IT is not a good enough reason for most people.
  • People’s criteria for selecting a new physician focus on human interaction skills and clinical competencies – not the physician’s Reasons For Changing Doctorsuse of EMRs and other Health IT (i.e., PHRs, web portals, etc.).
  • Similarly, people’s reasons for switching physicians have to do with changes in insurance, relocation, and the physician’s human interaction skills…not the lack of an EMR, PHR or patient portal.
  • 100% of people can’t agree on anything including EMRs – intuitively we know that seniors (who have the highest health care need/use) have a higher trust in their physicians and are less inclined to care one way or another about Health IT, other people worry about personal data security and so on.
  • A 2012 survey by the Markle Foundation found that “79 percent or more of the public believe using an online PHR would provide major benefits to individuals in managing their health and health care services.” Yet actual consumer adoption of online PHRs has been less than 10% for the last several years (with some notable exceptions like Kaiser, Group Health and the VA). There’s a big difference between what people believe or say they are willing to do…and what they actually do.

The Take Away

What people actually do or intend to do (behavioral intentions) are much stronger and reliable predictors of behavior (switching physicians for example) than attitudinal questions about their beliefs or potential willingness to do something in the future in relation to other behaviors they could engage in. The Accenture study would have been more instructive had it asked respondents to rate the importance of Health IT (EMR) in relation to other physician selection factors like the physician interpersonal skills, their knowledge and experience, etc. It would also be helpful for Accenture to inquire as to the respondent’s knowledge of EMRs and what constituted full versus limited access…and which is addresses the consumer’s level of interest and need.

There’s Nothing Engaging About My First Patient Portal…It’s Actually Pretty Disengaging

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Stop the presses!   I now have access to my very own personalized patient portal courtesy of my personal physician.  The big event occurred this last Tuesday.   I have to admit I was a bit excited that my doctor was slowly merging onto the information super highway.  Heck he even sprang recently for an out-of-the box EMR system which he is forever complaining about.

But my excitement was short lived.  Very short lived in fact after reading the e-mail from E-Clinicalworks (the patient portal vendor) which I am sharing with you here.

 

Patient Portal email

Now I realize that my doctor works in a solo practice as part of a large IPA…not the Mayo Clinic. But this email…and presumably everything associated with this patient portal is…well…very amateurish and totally disengaging.

First Impressions Matter

A couple of things immediately jumped out at me while reading this e-mail invitation to my patient portal.

The patient portal claims to offer me “the power of the web to track all aspect of my care through my doctor’s office.”That’s pretty powerful!

But I read on to discover that my physician’s concept of what I should have the “power” to do and what he thinks I should be able to do is very different. Why am I surprised…?

Firstthere is no mention of any kind of access to my actual health information…and certainly not my “physician’s notes.”But that doesn’t mean I am willing to leave my doctor for someone who offers this capability.

Secondand perhaps most galling…is that I can’t actually communicate with my doctor via the portal.  I can email his office staff…and maybe they will respond and maybe not. In the non-digital world they would get back to me at their own leisure.

Third… I can’t actually do anything on the portal (as configured by my doctor) other than request that the surly office staff intervene with the doctor to refill my prescriptions. Asking is certainly different than doing in my book. How the heck is this supposed to make me feel engaged?

Finally the email presumes to tell me that up until today my physician apparently does not think that I have been taking an active role in my own health care.   Let me get this right…I am 100% compliant with my medications, exercise, see my doctor regularly and am in good shape…yet I am not actively involved in my own health. Come on now.

In its favor…the email was personalized – it got my first name right. It never did mention my doctor’s name or his office address.

Upon getting this email from my doctor I was immediately reminded of a quote from a recent Dave Chase Forbes article about the value of physician-patient communications in which he said this about patient portals:

The smart healthcare providers realize simplistic patient portals, however, won’t get the job done. Simple patient portals are like a muddy puddle of water in the Sahara Desert — a big improvement but far from ideal.

Kudos to physicians everywhere that are trying…   But please recognize that your patients are not simpletons and that they are already engaged in their health at least from their perspective.   For portals like this to be successful – (meaning that patients actually use them more than once) – they need to offer real value (from the patient’s perspective), they need to be relevant to patients (not you or your staff) and they need to respect my intelligence.

Take Aways

Most patients are already engaged in their own health care.   The biggest challenge for providers today is not so much engaging patients but rather to avoid disengaging them.

Have A Patient Portal Experience You Want To Share?

I realize that my experience offers but one example of a patient portal gone wrong.   If you have samples of patient portal experiences you would like to share e-mail me at stwilkins at gmail.com.

What’s The Big Deal With Physician-Patient Communications?

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An Interview With Adopt One! Challenge Advisory Board Member Nancy Freimark, PhD

Nancy Freimark Phd

Nancy Freimark PhD

Here’s a recent interview I did with Nancy Freimark, PhD, an Adopt One! Challenge Advisory Board Member.  Nancy is a strategic communications consultant currently working in telehealth.  She is the former Director of Communications & Regional Director of Market Research for Kaiser Permanente in the Northwest where she worked for 15 years.

What is the big deal with physician-patient communications.  Why is it so important? 

“What’s the big deal?” That is often the first question that comes up in health care strategic planning sessions when the conversation turns to patient-physician communications. Senior leaders, impatient for results and schooled in Six Sigma process improvement techniques, will suggest the solution is quite simple. “Just tell the docs to smile more.” Then the discussion turns to activities that can be measured and managed such as through-put, performance, and optimizing Medicare reimbursement rates.

The big deal with patient-physician communications is the fact that doing it well can be both measured and managed because its downstream effects are observable and impressive. Patient centered communications is the lynch pin that holds together every other success in the health care environment. Communications is essential for establishing trust during the patient experience, encouraging adherence to a treatment plan, and generating positive clinical outcomes.

The argument has been made that patient physician communications skills are already high in the United States. A quick look at the various third party rating systems like HEDIS and HCAHPS indicate that most physicians are rated at 95% or better on patient communications. But these scores are a bit of statistical illusion because everyone can’t be in the top five percent of anything unless they live in Lake Wobegon where everything is above average.

More objective measures of the patient experience tell a different story. Deficiencies in communications lead to longer hospital stays, lack of compliance with treatment plans, less than optimal clinical outcomes, and a majority of patients not understanding what they were told by their doctor. In addition, nearly half of all Americans have health literacy problems including not being able to read or follow written instructions. From a stone cold business perspective, less than stellar performance in patient physician communications results in patient churn (patients leaving to find another physician or medical group) and reputation management issues.

How do think busy physicians and their teams might potentially benefit from participating in the Adopt One! Challenge?

Pursuing excellence in patient-physician communications is the new reality of health care. Gone are the days of medical paternalism where the physician issued directives and the patient did what they were told. Today’s health care consumers, aka patients, are their own advocates and expect to partner with their physician. They want to share knowledge, be respected for their opinions, and, most importantly, they want to be heard.

There are those who would make the case that information technology can do the same or better job of engaging and activating patients as the in-person office visit. What do you see the role of health information technology being in relation to clinicians when it comes to physician-patient communication before, during and between visits?

Health care technology can help improve the depth, breath and speed of patient physician communications by improving the sharing of knowledge and connectivity but technology is best used to enhance an already effective relationship. Without first mastering patient physician communications, no advancement in technology will increase productivity or engagement.

If you could make a recommendation to your physician, what one patient communication skill would you suggest they pick to work on and why?

Continual improvement in communications is the success formula for any customer facing enterprise, health care included. A great place for any physician to start is to focus on “Sharing the Why.” Too often, physicians and other medical staff assume the patient understands the “why” of an intervention (ie. It’s for your health, for your safety…), a recommendation, or a course of action. The specifics of the “why” are left unstated with the blank to be filled in by the unknowing patient. Critically important for improved patient-physician communications, therefore, is to prioritize the “why”. Encourage understanding. Ask probing questions. Leave time for information to be processed. Check for true understanding. Then check again.

The social contract between the patient and physician is evolving and that change requires everyone in the health care industry to learn how to be 21st Century partners. The most essential skill to leveraging an effective partnership is to embrace patient centered communications. It is the key to improved patient satisfaction, outcomes, retention, and revenue generation – all things that can be measured and managed.

More About Nancy Freimark, PhD

She has extensive experience leading customer-focused communications and market research strategies in the health care, government, and advertising/marketing industries.

Is The CEO Of The Cleveland Clinic Serious When He Says “No More Passive Patients”?

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If a recent blog post by the CEO of the Cleveland Clinic is representative of how health care executives (and physicians) really think about patients – aka consumers –aka people like you and me…we are all in big trouble.  In it Delos Cosgrove, MD, talks about how under health care reform there will be “No more passive patients.”

Here’s my a quote from the post by Delos Cosgrove, MD:

“For too long, healthcare has been something that was done to you. Now it’s going to be something you do for yourself in partnership with your doctor and care giving team. You’ll need to monitor your food input, get exercise, and avoid tobacco. ”

Let’s examine what’s disturbing about comments like this particularly when made by high-profile leaders like Dr. Cosgrove.

First, this statement is factually inaccurate.  Here’s why.  82% of US adults visit their PCP every year at least once a year (often more) for their health.   Think about the trip to the doctor’s office from the patient’s perspective… 1) chances are they have discussed their health problem or concern with family members or friends, 2) they may well have looked up information on their condition to see if it merits a doctor’s visit, 3) they make the appointment, 4) they show up for the appointment and 5) wait in the waiting and exam room thinking about the questions they want to ask their physician.

What about any of this suggests patient passivity?

Second, this statement misrepresents the true nature of the patient passivity of which Dr. Cosgrove speaks.  You see patients (aka people) are socialized by physicians beginning in childhood visits with Mom to the pediatrician to assume a passive sick role.  We are supposed to be passive! Otherwise the doctors gets irritated and ignores or dismisses what we have to say.  While it’s true that patients (even the most empowered among us) ask very few important questions during the typical office exam…the reason isn’t that we are passive.  Rather it’s because we don’t want to be too assertive, confrontational, and argumentative or are simply afraid.

Rather that blaming patients for not being more engaged…why don’t doctors try and become more engaging (e.g., patient-centered) to patients?

Third, patient non-adherence is often not the patients fault…but rather the result of poor communications on the clinician’s part. One recent study found that 20% of medication non-adherence is the direct result of poor physician communication with patients. Poor patient communication skills top the list of complaints people have with their doctor. Poor patient communication is also the leading cause of medical errors, non-adherence and poor patient experiences.

AdoptOneBigButtonFourth, how exactly are patients going to learn all the skills necessary to “do everything” for themselves?  The work of Lorig et al. has shown that simply providing patients with information – the “what” of self care – is not enough to change patient health behavior.  Patients also need and want to develop the skills and self efficacy for self care management – the “how” of self care.   Right now for example clinicians spend on average <50 seconds teaching patients how to take a new medication…and we wonder why patients are non-adherent.

Given the poor patient communication skills of physicians today how exactly are patients supposed to learn how to do it all themselves?

Finally, the Dr. Cosgrove reminds us of the kind of paternalistic, physician-directed thinking and communications which has gotten the health care industry into the mess it’s in.

The following statement says it all:

“If your doctor prescribes a medication, preventive strategy, or course of treatment, you’ll want to follow it.”

What if I don’t want the medication or don’t believe it will help me? Why should I be forced to do something I don’t want to do? Will you drop me as a patient?  What happened to the IHI’s Triple Aims?  What about the need to be more patient-centered as called for in Crossing the Quality Chasm and the ACA reform legislation?

I am sorry if I seem to come down hard on Dr. Cosgrove. But my original point remains…too many health care leaders still think and talk like this.  While they may “talk the talk”…employees, patients and physicians all see how such leaders “walk the talk.“  And as Cosgorove’s comments suggest we have a long, long way to go.

I would like to extend an invitation to Dr. Cosgrove and the physicians at the Cleveland Clinic to see just how “patient-centered” their communication skills really are by participating in the Adopt One! Challenge.   You will not only be able to assess the quality of your team’s patient communication skills but also see how their skills compare to industry best practices.

All physicians are invited to participate in the Adopt One! Challenge.

That’s my opinion…what’s yours?

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One of the biggest challenges facing health care providers today when it comes to engaging patients is RELEVANCE…or more specifically the lack of it.   I say “engaging” because any one presenting in the doctor’s office, visiting a patient portal or using a smart phone health app is already engaged in their health.   By engaged I mean they are already cognitively involved in their health to a certain extent with an end Relevantpoint or goal in mind, i.e., learn something, do something or decide about something.   Face it, who do you know that goes to the doctor’s office just for fun.  There is always a reason…and behind that reason is cognition, e.g., intellectual engagement.

Fact – 82% of U.S.  adults see their personal physician at least once a year (avg. is 3 visits/year) and yet experts tell us that most of us are still  unengaged in our health.  What’s with that?

Relevance Is Important In The Doctor’s Office

Now imagine a 55 years old person going into their doctor’s office because of a persistent headache and back pain.  Before deciding to see the doctor they probably talked with their family or friends about their concerns. Maybe they went online to research their concerns before making a doctor’s appointment.  Now imagine that same person in the exam room and all the doctor wants to talk about is the patient’s risk for colon cancer and the need for an overdue colonoscopy.  Bam. Instant patient disengagement.

To be sure, the clinician in this scenario is legitimately trying to “engage” the patient by getting them to comply with a recommended, evidence-based screening.  But there is a disconnect in this scenario between what the person (patient) wants to talk about during their office visit…and what the clinician wants’ to discuss.  The disconnect? A lack of relevance.  What the clinician wants to talk about is not nearly as relevant to the patient as it is to the clinician and that’s a problem.

Here’s another example of a common physician-patient disconnect.  Using the same scenario, imagine that the person/patient concerns regarding their headache and back pain have to do with how these symptoms are affecting their vision (ability to drive), their gait, their ability to sleep at night and their appetite.  For the person/patient, their quality of life is suffering as a consequence of their complaints.

Now consider that physicians – at least those with a physician- or disease- oriented style of communicating with patients (which make up 2/3s of primary care physician) – will focus during the medical exam on the biomedical causes of the patient’s complaints rather than the quality of life issues of concern to the person/patient.  Also realize that most patients are now very good or willing to interrupt or correct their physicians.  Bam. Bam. Instant patient disengagement.

Once again, while what the clinician focuses on may be the cause of the patient’s problems, it’s not relevant to the patient that wants to know how the doctor will fix their loss of vision, gait, sleeping and appetite.

This same scenario is played out every day in physician offices across the country.  Disagreement over the visit agenda isn’t the only reason for communication disconnects or gaps.  Lack of physician-patient agreement is also common when it comes to:

• What’s wrong
• Diagnostic tests needed
• Accuracy of the diagnosis
• Severity of the diagnosis
• Cause of diagnosis
• Appropriateness of the recommended treatment
• Expected efficacy of the recommended treatment
• Need for a specialist referral

Relevance Is Just As Important To Patient Portals

Finally, imagine that the Electronic Medical Records and Open Notes detailing the above scenarios are available to the person/patient via a patient portal.   Imagine also that the HIT folks used the patient’s diagnosis and doctor’s notes to “trigger” personalized, tailored health information for the patient.   That means that the patient is sent messages about this risk of colon cancer, information about diet and colon health and a coupon for a colonoscopy.

Now ask yourself…how in God’s name is the information provided via the patient portal in this scenario relevant or engaging from the person/patient perspective?  Explain to me how the information in the EMR and Open Notes is relevant to the patient if its ignored?  It’s not…and people/patients need only look at their patient portal once to figure that out.

The Take Away?

HIT’s current attempts at patient engagement remind me of the parable of “putting old wine (same old information) in to new wine skins (patient portals). The wine’s going to go bad and few will drink it. The solution is to add relevant, “patient-centered” wine into the new wine skins.

Patient engagement is not an HIT challenge…it is a physician-patient communication challenge. As such, the role of the clinician is to engage patients…but rather to be engaging or at the very least avoid disengaging patients.

That’s my opinion. What’s yours?

The Adopt One! Challenge – The First Step To Better Patient Engagement & Patient Experiences

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A journey of a thousand miles begins with a single step. Or in the case of the Adopt One! Challenge…by encouraging physicians across the U.S. to commit to adopting one new patient-centered communication skill in 2014.

Adopt One! Bullet Logo BigAnyone who has followed my work here on Mind the Gap knows that I am passionate about improving the way physicians and their care teams talk to and interact with patients. My passion stems both from my personal experiences as a health care executive, a patient advocate and patient. I honestly believe that if we could improve how doctors and patients talk with one another beginning in the exam room we would fix much of what is broken with today’s health care system.

“I have discovered that the biggest problem with physician-patient communications is the illusion that it ever occurred! “

Many physicians readily admit that their patient communication skills need work. But when faced with a burdensome daily practice schedule they make do with the physician-directed patient communication skills they learned in medical school. Besides…most physicians operate under the mistaken impression that patient-centered communications – the alternative to physician-directed communications – takes too much time and requires longer visits.

So How Will The Adopt One Challenge Help Fix Things?

The Challenge, to be launched later the Fall, is designed to accomplish three objective – behavioral objectives modeled after the Health Belief Model. These three objectives are:

Help physicians understand that their patient communication skills are not all they could be
Show physicians how their lack of patient-centered communication skills is a barrier to their ability to effectively engage and activate patients or to provide exceptional patient experiences
Serve as a “Call to Action” to prompt physicians to take action to improve their patient-centered communication skills

Here’s how the Adopt One! Challenge will accomplish these objectives:

Help physicians understand that their patient communication skills are not all they could be

Using audio recordings provided by participating physicians a team of independent, trained professionals will identify, measure and assess the patient communication skills employed by each physician. This research method – called conversation analysis – is the same method used in medical school. Unlike patient satisfaction surveys like HCAHPS which are not very prescriptive, the Challenge will provide participants with objective, detailed and actionable findings and recommendations.

Show physicians how their lack of patient-centered communication skills is a barrier to their ability to effectively engage and activate patients or to provide exceptional patient experiences

In addition to measuring and assessing their patient communication skills, each physician’s patient communication skills will be benchmarked against patient-centered best practices.

Over 30 years of research has linked the use of specific, patient-centered communication skills to more productive visits, increased patient engagement, better patient health outcomes, lower health care use and superior patient experiences. By comparing physicians’ skills against these “best practices” we show them how their communication practices may be affecting patients, their practice and the organizations they work for or with. We also show them which communication skills they may want to focus on improving.

Serve as a “Call to Action” to prompt physicians to take action to improve their patient-centered communication skills

The Challenge serves as a concrete call to action to physicians to take a specific action to learn a new patient-centered communication skill over the course of 12 months. This call to action will require participants to 1) commit in writing to adopt/develop one new patient-centered communication skill of their choosing and 2) provide them with access to online training and resources needed to help them learn that new communication skill.

Because the Adopt One! Challenge is expected to become an annual event, participating physicians can measure their year-over-year progress as they add new patient-centered communication skills.

In future posts I will share more about the Adopt One! Challenge. In these future posts I will profiling members of the Adopt One! Challenge Advisory Board as well as the Partners that are making the Challenge possible.
The Adopt One! Challenge is Free To Individual Physicians.

If you are interested in offering the Adopt One! Challenge to all the physicians in your provider network? E-mail us at contact@adoptonechallenge.com.