Sharing the load: How to help patients help themselves

Call me sentimental, but I celebrate every publishing anniversary of FiercePracticeManagement as though it were the birthday of my third child--sans the piñatas, face paint and sugar-crash tantrums. Another marked difference between FPM's milestones and those of my offspring is that I don't get to marvel at how, year over year, the newsletter becomes more self-sufficient.

But while I'm sadly no closer to this publication writing itself, I would like to commemorate four years' worth of articles advising you on how to run your practice with some thoughts on how you can get a little help around here. Specifically, let's talk about how you can "raise" your patients to take on more responsibility for their health and experiences with your practice.

A recent article from the Washington Post offers a good starting point--addressing healthcare consumers directly and urging them to take action to avoid becoming one of the12 million outpatients who find themselves misdiagnosed every year.

I haven't asked any physicians if they're offended by articles like these, but to those who might be, I ask you to remember that this isn't about having patients do the physician's job, but simply participating as active members of their own care teams, doing their part to ensure communication is coordinated and information does not slip through the cracks. Your electronic health systems and staff already go a long way toward plugging these gaps, but why not recruit the one person who's actually present for his or her every encounter with the healthcare system?

If you don't do so already, formally encourage your patients to take the following actions:

  • Give detailed information to schedulers, particularly about new problems, so they will allot the appropriate amount of appointment time.

  • Bring a list of medical complaints, a symptom/side effect diary if applicable and information about medication regimes.

  • Bring a family member or friend to help the patient remember and understand what transpires during the visit.

  • Contact the office about test results if the patient doesn't hear back within the predicted time frame.

As you can see, many of the Post points overlap with existing practice management advice. But the other idea I'm going to bring up is less tested. As we've discussed extensively over the past year or so, health reform ups the ante for patient engagement.

A couple of months ago, I had a conversation with Molly Cooke, M.D., a practicing internist and immediate past president of the American College of Physicians, for a Medical Economics article about diabetes management in primary care. Inevitably, we talked about how physicians could better encourage behavior change in patients. Here are some comments excerpted from the article that stuck with me and I'd like you to think about:

I wish we understood better how to get people fired up about their chronic illness. The contrast for me comes from my early experience taking care of people with human immunodeficiency virus (HIV). They were [angry] that they had HIV and many of them fairly skeptical about their physicians. … I usually found that I could take that energy and really focus it on what the patient needed to do well. I began wondering why patients with diabetes often have an almost fatalistic attitude about their diabetes, and wishing I could transplant some of my HIV patients' energy into my diabetic patients. I'm sure that there are ways to do that, but in general as doctors, we are not very good at it.

Even though Dr. Cooke didn't offer a definitive answer as to how to use this insight, the idea certainly struck a chord with me. Perhaps it's because I, too, witnessed the contrast between a terminal cancer patient who did everything possible to enhance his health and the quality of the scant days he had left, compared to others with equally deadly chronic illnesses who continually tempted fate by insisting they can't quit smoking or embrace nutritional eating. To be clear, the latter group are no less worthy of medical help than anyone else--but something about the current approach just isn't working for many.

Thankfully I'm not a doctor, because I'd be liable to lock a few people from each group in a room together and let them teach one another something about perspective, about fortune and the ability to influence their own existence. But it's probably not okay to do that.

So with no further ado, I'll turn the microphone back to my wisdom-filled audience. Whether the change you need is practical or profound, how do you help patients help themselves? - Deb (@PracticeMgt)