As of late, patient engagement has been laudably deemed a “miracle drug,” a silver bullet slicing through the tangled morass that is our American healthcare system. The comparison may be hyperbole, but the potential impact of patient engagement does have merit. With engaged patients, medical problems can be diagnosed swiftly and treated with higher success rates. Illness can be prevented and emergency department usage can be abated. Care can be personalized to improve outcomes that matter to providers and patients.
In the process, patient engagement can indeed perform a miracle: It can combat voracious healthcare costs.
Still, drugs (even miracle drugs) only work when used correctly. Patient engagement can work effectively, but healthcare must first be geared towards making patients feel and live better. Enter: Obamacare, ACO’s, patient centered medical homes, bundled payments, lean management and the entire quality movement. These initiatives attempt to reorganize healthcare with patients at the center. Yet for better or worse, healthcare institutions cannot govern patient behavior. Thus, patient engagement becomes the last piece of the puzzle, and evidently the most evasive piece, making it all the rage in today’s healthcare discussion.
Let’s nosedive into the discussion: How do we engage patients in routine care? Technology is the sexy answer. Here is a list of technological options/ideas to engage patients:
- electronic health records
- patient portals that enable patients to:
- view their medical record
- view lab and other test results
- schedule appointments
- ask questions and communicate with providers
- explore educational resources regarding specific health condition(s)
- patient reported outcome measures that quantify, track, and compare patients’ overall health and quality of life
- passive, mobile trackers such as Nike Fuelband, Fitbit, Jawbone, etc.
- telehealth devices that monitor and exchange information about blood pressure, glucose levels etc.
- medical adherence trackers that remind patients to take their medications
Technology serves as the hook for patients in a versatile way, and more inventions are sure to come soon. Health technology’s promise has even garnered the attention of some protagonists in healthcare such as the Centers for Medicare & Medicaid Services with the meaningful use initiative. Meaningful use stage 1 incentivizes collecting and reporting health information via electronic health records, where stage 2 focuses on the exchange of that information between provider and patient. The principal aim of meaningful use is to engage patients by empowering them to view, track and discuss their health at their convenience.
Although it is fresh, fun, and may stimulate the economy, technology has innate limitations. A significant population of patients is unfamiliar with modern technology, and unwilling to use it. As more and more confidential health information is shelved to the Internet, a continuous stream of dollars must flow to electronic security. On top of that, technology requires user training for all parties involved.
Technology cannot and will not be the black box that saves American healthcare. It has been the default answer because it is the easy answer, not necessarily the best answer. The task of engaging patients has hot-potatoed into technology’s hands because no one else wants to take on the challenge. Engaging patients is a tough job: no strategy can guarantee success, and nurses, MA’s, PA’s, social workers, and physicians are already overworked.
So, what is the answer? 21st century pharmacology has taught us that there are no silver bullet drugs, but there are silver bullet drug cocktails. Accordingly, technology cannot be the sole answer, but must be used in conjunction with other tools, strategies, and mindsets. To exhaust other options, and to progress to the next step in the quality era of healthcare, it would be diligent (hopefully entertaining, at the very least) to look to a different field, one where engagement has long been a pervasive problem.
In Latin, doctor means teacher. Education and healthcare share a fundamental similarity in that they both provide services that lie in a nebulous gray area between human right (socialism) and consumer product (capitalism). The two have followed divergent trajectories, influenced by government, wars, inventions and even natural disasters, and both systems are plagued by unique sets of problems that rarely escape political discussion.
A stark distinction is evident in law: education is considered a compulsory right by each state’s government. Still, mandatory attendance does not equate to engaged (nor happy) students. Just like patients and their health, some students’ enthusiasm doesn’t match the ostensible benefits of a strong education.
Here are some educational tactics to battle lack of engagement that could crossover to healthcare:
- Fun/excitement: Students habitually complain that school is the same old boring routine. Projects, experiments, and games can break the monotony to make learning fun. Health providers could benefit from avoiding routines, and expressing more excitement about their work.
- Real world application: Some students can’t visualize the benefits of education because they are too far away (e.g. getting a good job). Health benefits are sometimes hard to visualize as well (e.g. lowering LDLs). Providers could emphasize the fact that being healthy makes you feel and look better (although it won’t happen overnight).
- Family involvement: When a student is struggling, teachers are quick to call home. This isn’t solely for punitive purposes. Students sometimes forget that others care about them, and can be inspired to impress their loved ones. Patients might also be inspired to improve their health when reminded that others care about their wellbeing.
- Peer groups: Teachers often split students into groups to work. Sharing similar experiences, thoughts and concerns can provide support that often breeds success. Patients may find solace from others in similar health situations, which may encourage them about their own health.
There is a common thread in the above list: teachers. Sure, there are systemic solutions that focus on recess, school start times, and day length. However, the duty of engaging students is that of the teacher. Teachers are trained and expected to imbue student engagement to the best of their ability.
Teachers take on this role knowing that student engagement performs miracles that benefit students and teachers alike. It stimulates learning and allows students to shape their aspirations. Simultaneously, student engagement minimizes classroom disruptions and allows teachers to reach a higher percentage of students.
Medicine would benefit from an emphasis on providers to engage patients, although it would require a substantial culture shift. Seeds would need to be planted in medical school with classes dedicated to patient engagement. Primary care needs to be redesigned, notably with a more robust reimbursement model that will attract more medical students. Taking histories, and other patient interactions need to be tweaked to collect information that matters to patients. Most importantly, a new infrastructure needs to be constructed that gives doctors the time and reason to engage their patients. Providers need to be valued and commended for their care and respect for patients, rather than for performing tests. Just imagine if education was based on fee for service.
Still, lack of engagement remains a problem even in education. The causes vary, ranging from disinterest to social issue to physiological condition. Teachers do not have control over many of these causes. Therefore, a more profound connection between students/teachers and patients/doctors must exist to fight those precarious causes. The said connection can only be established if teachers and doctors persistently radiate a set of qualities that they do have control over. These qualities fortify engagement by fostering mutual respect. To truly stand up and fight to engage students and patients, teachers and doctors need to strive to be:
- good listeners (student and patient voices need to be heard and valued)
- trusting (trust prefaces honest communication)
- team players
- believers (to generate self-belief)
And lastly, teachers and doctors should not forget that their primary role is to care.
My credentials: student for 20 years, patient for 24 years.
James Dominic O’Brien will be attending medical school this fall. He blogs at the j.o.b. method.