Engaging Patients

Patient satisfaction is hot. Major payers, including the federal government have linked hospital payment to institutional performance on patient surveys of their experience with care, and are poised to do the same with physician payments. There is a proliferation of commercial websites for patients to offer up their reviews of physicians and to check out the ratings already there. An entire industry of consultants has appeared to help institutions improve how patients experience the care they provide. Hospitals and health systems, including our own, have hired Chief Experience Officers.

I think that this is generally a good thing. We have traditionally paid too little attention to how patients actually experience the care we provide, and it is pretty hard to make that experience better without actually asking patients and their families. I would be more enthusiastic about these efforts if we spoke less about “patient satisfaction” and more about “patient engagement.”

As I have written previously, I think that “satisfaction” is a pretty low bar. Patient engagement, however, is a much higher goal of establishing a therapeutic partnership with patients. It is not just about making sure that they were, as the patient satisfaction surveys would have us assess, spoken with in a way they could understand, or treated with courtesy and respect. It is about making sure that we have made it possible for them to be active and effective in their own care. A really eloquent statement of what that ought to look like is available here.  It is written as an open letter from a patient to a “new doctor” and we would all do well to follow her advice. I recommend you read the whole thing, but her main points of advice to us are:

  • Seek first to understand, then to be understood
  • Join a system or create a practice that prioritizes coordinated care
  • Recognize that being a patient and being part of the health care environment is not my job
  • Learn from me

I know it is not easy to organize our systems of care to achieve these goals, but it really seems to me we ought to try. What do you think?


4 thoughts on “Engaging Patients

  1. Hi, this is good in many ways. I enjoyed and agree with the content of current surveys. They ask if the doctor politely explained the treatment in words that I understand. They don’t have anything to ask what my response to the treatment is. They don’t ask me if the doctor is a bully that is intent on getting a 100% compliance with one of their wars on statin-mammograms-CVAs-diabetes. The doctor is a bully because they are bullies. They don’t have a check box that my ‘NO’ was heard. That my NO was being respected.

    They don’t ask me if their pharmacy system respects me. I can’t break T4 down into T3 if I’m given a synthetic thyroid hormone replacement. My body doesn’t give a damn about the edicts from the FDA, NIH, and the Medicare pharmacy formulary edicts. Don’t they realize how much easier my life would be if I could take a synthetic? That it can be difficult to find a doctor that prescribes what I need?

    I’m meeting a new PCP on the 30th. I have incurable cancer-am in remission. My first question will be, “Would you prescribe Armor Thyroid?” “Would you be upset if the HMO pharmacy board contacts you that I’m non-compliant with FDA, the medicare and HMO pharmaceutical formulary rules about using a synthetic?”

    I lost a good doctor because he got tired of fighting the pharmacy board. I was hospitalized for a bad case of pasteurella multocida. They were getting blood, starting an IV with Augmentin, asking about my diet, my meds, showing the call button, taking med history, how to run the bed, TV, phone, telling me when the kitchen was open-how to get food when it was closed, hold my urine-they needed a sample, what was my birth date, did I want a back rub, what were my allergies, etc.

    I went in to see my PCP. “Why did you tell them I prescribed Armor thyroid? I scribe it. It was prescribed in the 1980s by the first doctor that diagnosed it. The rest of us write a script, scribe the order. They never stopped complaining and it’s on my file.” He just couldn’t take it anymore.

    I thought that I did a good job of saying that synthetics make me aggressively crazy. I don’t have troubles with Armor. I know that I have to avoid some meds, mostly OTC cough, allergy, cold-flu meds. Isn’t it easier to have me sane-let me make my own cough syrup from a 1930 army recipe of tea-honey-and fresh lemon juice, instead of being sick? And with all of that going on somebody really ragged on my doctor. I think other things were going on-as he might have had cancer or something-maybe personal problems. I never asked, but he reminded me of 3 doctors that I had that died from cancer.

    I’m so tired of “No’ being hard for these doctors to understand. The surveys never ask if I agree to the treatment-diagnosis. There’s a difference between understanding it and accepting it.

    1. Agreed. I’ve seen your posts before, and I’m so very sorry for the way you have been treated. I’ve had something of the same issue but I get the cops called me for doing nothing illegal or even “concerning” by the officers except for being on public property in the vicinity of the area. I can certainly understand your issue.

    2. Hello, please let me know about the pasteurella multocida you had. I just had it show up a nasal culture. My doctor hasn’t said anything about it, yet. How did you get it? I take Armour, too and I have dogs. I’m seeking information and appreciate your help. Thank you

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