Patient Engagement: I Do Not Think It Means What You Think It Means

Jessie Gruman, PhD has an important post on Dr.Kevin Pho's Blog - Patients and clinicians don’t have the same goals in mind. Patients have a different view of what active patient engagement in healthcare means from that of clinicians, insurers, employers, or policy wonks.

... This divergence of aims between patients and those who organize, deliver and pay for our care doesn’t alarm me on most days. Each stakeholder is working to standardize incentives, processes and programs that they believe will provide the best chance for the greatest number of us to get care that is safe and effective. On average, I am grateful.

But I know that these stakeholders don’t view patient engagement as an expression of our individual needs and preferences. Rather, for most of them patient engagement is synonymous with our compliance with our clinicians’ evidence-based recommendations to lose weight, control our blood sugar, use prescription medications as directed and abstain from frivolous use of the ER. For them, our engagement in our care is the expected consequence of believing that scientific evidence shows – and our clinicians know – that certain behaviors and treatments will produce the best outcomes for most people. They are convinced that any rational individual will act consistently with that understanding. Many narrow-minded economists would agree.

Some professionals have sounded alarms about this conflict between the goals of patients and the goals of health care. 

Real patient engagement begins with the doctor - patient relationship or perhaps more aptly stated, the patient-doctor relationship. Individualization is critical to this concept. The problem is that tailoring of therapy to fit the patient's needs often runs counter to protocol-based medicine. While the evidence should be a jump off point, protocols are just that - the beginning not the end of the discussion. What works for the area under the curve might not be appropriate for the patient under the examination gown. This is the quandary we face today as conflicting megatrends of Best Practices butts heads with real Patient Engagement. Fasten your seatbelts.