The medical exam wasn’t designed to engage patients

Primary care physicians are the point of first contact that people like you and I have with a hospital or health systems.   We are 13 times more likely to visit a primary care physician in any given year than we are to need a hospital stay.

Primary care physicians are very important.   Yes they are they the first line of care for many people.   The primary care physician’s office is also the  “make or break” point for “engaging the patient.”

What people experience have experienced in primary care physicians’ offices  in the past tends to “shapes and frames” their expectations of future health care experiences.    Patient complaints about doctors that don’t listen, long waits, etc. are as much a reflection  of our collective life-long experience as they are the reality of any one physician.   So it is with the tendency of patients  to stay disengaged from their health care.   That’s what we as patients are taught from childhood.

What’s the point?

The point is that the medical exam – the most frequent point of contact between patients and the health care – was never designed to engage patients.  This is the same “medical exam process” taught in medical schools to this day.

The medical exam is a highly structured affair.  It doesn’t just happen.   It consists of 6 steps or processes that physicians move the exam through with the single goal of diagnosis and treating the medical problem

The most important “take away” from this graphic is that patients – people – are invited to freely speak only during the 2nd step – the patient’s opening statement.  This is where people tell the doctor the reason for their visit.   Even then…patients are often interrupted before finishing their story.

From this point of the medical exam on, the patient’s role – aka the sick role – is to answer yes or no to their physician’s questions.

How can physicians, hospitals or health systems ever hope to truly engage patients in their own health  care when the heart of the heart of the health care system – the medical interview – is so un-engaging?

The key to patient engagement: High quality patient-centered communication

Patient-centered communications by definition is tailored to the patient – their beliefs, fears, concerns and past experiences.   It invites patient input and participation.   It engages us in important conversations with our physician that would not otherwise occur.   When practiced over time, patient-centered communications will enable physicians to accomplish more…in shorter visits…while creating exceptional patient experiences.

Hospitals, health plans, and ACOs looking to engage patients should begin by looking to ways to help their physicians adopt more patient-centered communication skills.   Simply providing them with EMR systems and care coordinators is not enough.   Going forward, those physician groups and hospitals most successful at engaging patients will be the ones that are the most patient-centered where it counts – physician-patient communications during the medical exam.

Steve Wilkins is a former hospital executive and consumer health behavior researcher who blogs at Mind The Gap.

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