Making Healthcare Better with Patient Engagement

HealthLeaders Media Staff, December 16, 2009

The trend toward patient engagement has been building slowly for a long time, now. (Very slowly: Remember when it was called consumerism?) No, we're not yet at the stage where consumers are using price and quality data to make decisions about where to go for care, but they are getting better at taking charge of their health: researching their health conditions online, bringing what they've found along with lists of questions to their annual physicals to share with their docs, and beginning to demand more convenient communications and scheduling options, such as e-mail and online.

Spreading the word among patients
This year, two patient engagement advocates made our annual list of 20 people who make healthcare better, and they happen to be a patient and his physician: Dave deBronkart and Daniel Sands, MD.

I interviewed them together and their relationship is remarkable—it is much more evolved than the stereotypical paternalistic physician and passive patient. They are more like partners–sharing information with each other and spreading their passion for patient engagement to others as well.

I think that as the general public hears more about patients and doctors like deBronkart and Sands, the more people will want to have that kind of relationship with their own physicians.

"We're spreading the word," deBronkart says. "And sooner or later everybody will be headed to our party."

Getting docs on board
I love that. But if every patient in the U.S. woke up tomorrow morning and decided they were going to become an engaged patient, they would probably find a big stumbling block: There are still plenty of physicians who are skeptical, stuck in their doctor-knows-best ways, or just don't think they have the time to practice this kind of healthcare. I wrote about that a bit in my article for HealthLeaders magazine about the patient of the future, noting that doctors don't get paid for phone or e-mail consultations, nor do they want to risk missing a diagnosis because they chatted online instead of face-to-face with a patient. Physicians have five to 10 minutes to see a patient, listen to his or her complaints, make a clinical decision and move on to the next appointment—there's hardly enough time to engage on a personal level or listen to a patient's summary of all the cool information he or she found on WebMd.

"We still hear about people whose doctor tells them, 'Look, who has the medical degree here?'" deBronkart says in that article. But the best way to improve medicine is to make it more collaborative, he adds. "It may be that this new form of relationship is not nearly as burdensome as people might reasonably anticipate . . . The reality is that there is an enormous flood of new information being published. It's just more than anyone can keep up with."

Another thing that might start to bring docs around: Studies that show patient engagement can improve clinical care.

A new study on shared-decision making, where the patient and physician share information and decide on a course of treatment together, found that patients who were more involved in their care were less likely to undergo risky treatments. Other studies have also suggested that the perception of risk is increased under conditions that emphasize choice.

"We found that highlighting the perception of having a choice increases patients' worry about the risks of adverse events and decreases their willingness to accept treatment," said Yale University School of Medicine's Liana Fraenkel, MD, co-author of the study, which was published in the journal Arthritis Care & Research. "Having knowledgeable and highly engaged patients making informed decisions is a requirement for ensuring high-quality healthcare."

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