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 Neighborhoods, 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 (which is gateway to the following…)
- 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.
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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)
- Open
- Team players
- Sacrificing
- Believers (to generate self-belief)
And lastly, teachers and
doctors should not forget that their primary role is to care.
James
Dominic O’Brien, future medical school student
