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Physician-Patient Engagement Model Is Wide Open

 |  By jcantlupe@healthleadersmedia.com  
   October 31, 2013

Whether using simple techniques or complex technologies, physicians must consider a patient's social needs in order to engage them and elevate care, say panelists at Partners HealthCare's Connected Health Symposium.

Alicia Cole of Sherman Oaks, CA, is a survivor ofnecrotizing fasciitis—flesh-eating bacteria—that she contracted following routine surgery in 2006. She was bedridden for months and needed more surgeries to overcome her devastating ailment.

The struggle and trauma was bad enough. Yet there was something else that really troubled Cole during her hospital stay: Healthcare providers and nurses weren't calling her by her name.

"Being in the hospital for two months, it's very disconcerting to have someone refer to you, standing right there, and talking about 'Patient 25.' I'm thinking, 'You know me.' My name is Alicia. Please refer to me in that way,'" Cole says. "It dehumanizes the patient. There is a disconnect," adds Cole, who has formed a patient advocacy group, Alliance for Safety Awareness for Patients.

In East Greenwich, RI, Pat Mastors recalls a generally more positive experience when she maintained a day-and-night hospital vigil for her 26-year-old daughter who was hospitalized when suffering Guillain-Barre Syndrome.

Although she ran into staffers who said, 'Sorry, that's not my job,' Mastors researched her daughter's illness and needs, and "compelled [healthcare staff] to connect."

"They stepped up their game, they really worked as a team, I saw this happen many times, " Mastors says. Once, a physician in leadership helped push her daughter's gurney, to the surprise of other staff. "A technician holding up the rear of the gurney said, 'Oh, my God, I've never seen the chief of radiology move a patient before,'' Mastors recalls, seemingly stunned by hospital politics.

Mastors also learned the importance of patient or family involvement in care when her father died seven years earlier from complications following a surgery that, she says, "made no sense to me." She created and is CEO of Pear Health LLC, maker of a patient engagement and empowerment tool.

Patients Can Help Shape Care Plans

Patient focus is something that needs to be welcomed, not discouraged, says David Judge, MD, medical director of the Ambulatory Practice of the Future at Massachusetts General Hospital in Boston. This program establishes a process in which there are health coaches designated for each patient, in part to free up physicians to spend more for patient care. Patients, too, are dubbed as "experts" in their care. That distinction is crucial, Judge says.

"The experience on the care team is very rewarding," he says. "It blows us away."

Despite the positive outcomes demonstrated by his program, some physicians resist patient engagement, Judge says. He notes that Massachusetts General Hospital uses a patient portal that details precisely what physicians are doing and why.

Some doctors think it's "crazy" to set up a patient portal. But, he says, patients "are going to see what is being put on the chart. There's nothing crazy about that, it's fantastic and safer [care]."

"We engage patients in designing a process. They need to be at the center of care and experience to design what they need, what they want," says Judge.

Unfortunately, "you have to understand how our own [physicians'] traditions run counter to that," he adds.

Connected Health

Cole, Mastors, and Judge were among speakers at last week's Partners HealthCare's Connected Health Symposium in Boston, which focused on collaborations and innovations to engage patients and elevate care.

Part of "connected health" is focusing on simple tasks, such as remembering a patient's name; or rethinking care processes, such as teaming with patients and their families.

Such work comes against the backdrop of many technological developments that could be implemented to improve patient care. Patient advocacy representatives, consultants, and vendors at the Connected Health Symposium pointed to new dashboards that help patients collaborate with physicians and empower the patients to take themselves off medications. An innovative facial recognition computer program was touted as a way to help monitor a patient's medication adherence.

Whether using simple techniques or complex technologies for patient engagement, physicians must consider a patient's social needs, and may need to weave more of that into care plans beyond the routine patient-physician visit, panelists said.

That's what Massachusetts General Hospital's patient advisory council tries to do, Judge says. Patients are asked "How do you define health and wellness; what is your goal?" he says. Often, the answer is not straightforward, he says: "It's not my blood pressure, it's the kid who may be on drugs, the boss. That's a big lesson for us."

Rebecca Onie, co-founder of Health Leads and a winner of a MacArthur Foundation genius award, has operated clinics in which physicians not only prescribe drugs for patients but also advise patients what kind of food they should eat, or suggest they raise the thermostat in the home.

"Every day we have patients who come into the clinic with asthma exacerbation, but I know the real issue with the patients there is no food at home," Onie said at the Connected Health Symposium. "The other issue is they are living in substandard apartments filled with asthma triggers."

"The realities of my patients' lives are outside the four walls of the clinic," she says. That's a lesson for all healthcare providers.

Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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