“Patient engagement” is a buzzword in health care these days, but what does that look like?
Professionals in health care believe patient engagement means improving communication between doctors and patients. And for good reason- they also believe that doctors and patients need to communicate better.
Patients complain that doctors don’t listen to them or respond to their questions and concerns, don’t spend enough time with them, and don’t use language they can understand.
Physicians feel frustrated when patients ignore their advice, misinterpret instructions, and seem uninterested in their conditions and treatments.
The main problem with health care communication is that it involves people- and people frequently communicate poorly, and sometimes not at all. It never will be perfect. But we can do better.
So what is true patient engagement anyway?
Dr. Rob Lamberts writes
“Engagement is about interaction, listening, and learning in relationship to another person.”
Barbara Ficarra, R.N. , puts it this way:
“Patient engagement is a connection between patient, caregiver and health care provider.
An empathetic and trusted relationship forms and mutual respect is fostered.
Patients and their families are empowered and they are active in health care decisions.
Those patients and consumers who choose to be actively involved and in charge of their health work together with their health care providers to successfully reach their health goals and needs.”
Many leaders in health care believe doctor-patient communication is less than satisfactory, so they are teaching physicians how to talk to patients more effectively. But to be engaged and empowered, patients need to develop skills also, and learn to approach their physicians in a way that is perhaps different from what they have done in the past.
I like to start with the basics. What do I mean by communicate?
The dictionary defines it as – to convey or exchange information, thoughts and feelings. Therefore, it’s not just about words.
It can also mean to join or connect.
The definition which I think most applies to this topic is
Communication is –a connection allowing access between persons
I believe the first, and most important step in communication is establishing that connection, or relationship.
If we try to start exchanging information, or even thoughts and feelings before we have established a connection, it is like to be unsatisfactory.
For example- think about a recent retail service experience – one that worked and one that didn’t. Perhaps it was a call to customer service to get a phone service problem resolved. Or maybe you went to a car dealership and interacted with a sales person. Whatever the situation, and whatever the outcome, you probably rated it more favorably if you felt connected with the person helping you.
Recently I called my medical insurance carrier to resolve some unpaid claims- and my insurance is through a government agency. I dreaded the call, expecting a difficult unpleasant conversation. But the rep was professional, efficient and confident. She started immediately by telling me her name and position, then asked me my name. She then accessed and reviewed my account, giving me feedback about what she found. Then we started working on my problem, and continued until it was resolved. I was surprised to have the situation taken care of not only efficiently but pleasantly.
I propose there are three keys to effective communication; realizing there is no one right way, no one size fits all. Each person and situation is unique, with different personalities, and styles of relating. Some or all of what I suggest may not be appropriate or work in some situations.
In dealing with others be willing to be frank , flexible and forgiving.
Approaching others with generosity, grace and gratitude makes it easier to connect.
“Hello, my name is Dr. Oglesby, and I’ll be examining you today.”
Customer service depends on connecting, and that usually starts with knowing who you are dealing with. The first item we exchange in any human interaction is usually our name.
You should learn not only the name of your doctor (and other health professionals; I’m going to concentrate on physicians in this post) but also their specialty– internal medicine, cardiology, psychiatry, etc
What is their role in this patient’s care? Is this doctor primary or a consultant, and
what issues are each managing? (especially in a hospital situation)
And they should know the same about you and any family members who are actively involved in your care. Tell your doctor what name you prefer to be called if it’s different than the name on file. Your doctor should know who is your legal next of kin or who has POA (power of attorney if applicable)
Introduce other family and friends and identify the primary contact person; this first level of receiving and giving information, is especially important in the hospital setting. This will create continuity as the doctor speaks to the same person every day.
If you take a friend or relative to your doctor’s office with you, make sure they understand what their role is. Your family’s insights and observations provide helpful information to supplement what your doctor learns from you. They can help you remember and understand answers and instructions. But this isn’t a time for them to discuss their own medical issues with the doctor.
The Setting- where you interact with your doctor, is important but often overlooked; as the patient you likely will have little control over this, but is a factor to consider when choosing a doctor or hospital in advance. If you are already in a medical setting, giving feedback if there are issues that make you uncomfortable.
A hospital setting is different from an office, but some general principles apply.
Ideally it should be as comfortable as possible, private, and quiet, so you can hear and see each other well. In the hospital, ask visitors to leave.
Friendly greetings are fine anytime you encounter your doctor, but discussions of personal medical information don’t belong in the hallway, elevator, or cafeteria. Likewise, if you run into your doctor at church or the grocery, just say hello.
Come to an office visit prepared. If you have test results, previous medical records, xrays, etc. bring them with you. Not all doctors will request it, but most will appreciate an up-to-date list of all medications you take, or even bringing the meds with you. Turn off your phone. Bring a friend for support but not a social visit.
Expectations about time can create conflict, whether the visit lasts longer or shorter than you expect. If you weren’t told, ask the office how long the appointment is for, realizing that it will only be an estimate; it will depend on what you and the doctor end up discussing and what you need done.
Showing up on time helps the office keep to their schedule and shows the doctor you are serious about your care and respectful of other patients’ time. If the office is consistently poor at time management, address it respectfully; sometimes it is best to move on if this continues to be an issue that bothers you.
Most hospitals and clinics have abandoned paper charts for computers, using electronic health or medical records- EHRs or EMRs. I’m not going to dwell on it now, but computer use in the exam room or bedside has changed the dynamic between doctors and patients in ways that often are not compatible with connecting and communicating. For now, I’ll just tell you this is a problem doctors recognize and are working to make computer use more patient and doctor friendly.
Connecting with your healthcare providers depends on acknowledging feelings- depending on the current status of the illness, progress to date, future prognosis, there may be a range of emotions – worry, fear, despair, hope, relief, anger, resentment, frustration. Give feedback respectfully; if anything about your care is not as expected, or doesn’t seem appropriate, or you just don’t understand something, speak up.
Expressing feelings honestly and respectfully, and listening with empathy and respect can build the trust that is vital to creating a connection for effective information exchange – conversation.
Here is a previous post where I discussed the importance of communication between doctors and patients.
And here is how one medical school is helping students learn The Art of Communication
In the next post I’ll talk about how to talk to your doctor so you get the information you need and can understand.
E Rob Lamberts is an internal medicine-pediatrics physician who blogs at More Musings (of a Distractible Kind).