Tips to Successfully Engage Patients in Their Own Care

Getting patients more involved in their own care is becoming more important in healthcare today. It has always been necessary, but now and in the foreseeable future patient involvement will become more important as physicians and healthcare organizations financial success will depend more on patient involvement. For instance, the patient-centered medical home involves the patient at many levels and Medicare and private payers will be rewarding primary care physicians and organizations for the level of involvement of clients in their own care.

In the Institute of Medicine’s Crossing the Quality Chasm several of the ten recommendations for modern healthcare call for more patient input. For instance, under customization based on patient needs and values, the IOM recommends that the system of care should meet the most common types of needs, but have the capability to respond to individual patient choices and preferences. Under patient as the source of control, it recommends that patients should be given the necessary information and the opportunity to exercise the degree of control they choose over health care decisions that affect them.

The patient-centered medical home, a new concept in primary care growing out of the IOM’s recommendations, further details the level of involvement of patients, especially in the area of chronic care. In its guide for becoming a NCQA accredited patient-centered medical home the NCQA makes these recommendations:

• Writing individualized care plans

• Writing individualized treatment goals

• Reviewing self-monitoring results and incorporating them into the medical record at each visit

Obviously, the patient has a major role in his/her own care in this model.

If you accept that a patient must become more involved in her own care, then you probably also realize that the involvement of the patient becomes more complex as the patient’s disease becomes more complex. For instance, the involvement of a patient with a simple broken finger isn’t very complex. A few simple instructions will suffice. The involvement of a patient who is pregnant is much more complex. Not only is the physician directly involved, but there are also classes that the patient needs to attend so that she can better care for herself and the fetus. Yet, this prenatal care has a definite beginning and ending, a successful one, we hope. The involvement of a patient with a chronic disease is much deeper and more complex. In fact, because patients with chronic diseases often need to make significant life style changes, the planning of care and execution of the plan require a delicate orchestration of activities, including a major part for the patient himself.

Now that I have made my point that patients need to be more involved in their own care in order to insure positive health outcomes and also to help physicians to meet performance goals, I must ask again, “How do you get the horse to drink?” The answer can be complex.

Perhaps we can borrow from examples of other businesses or services that are successful with their customers or clients. I don’t think that a business which provides a physical product would be of much use, as there is not a lot of direct communication between the business and customer usually. For instance, I don’t go on at length with a salesperson from J.C. Penny about a shirt that I buy. Too, a model based upon purchase of a service usually doesn’t require a lot of interaction between business and client. I certainly don’t need a lot of instruction from the person who cuts my lawn. The best model that I can think of is that of teacher and student. In both healthcare and schooling there is a lot of trust between those with the knowledge-teacher or healthcare provider-and the recipient of the application of the knowledge-student or patient. Too, the student and patient should be very involved. The best students and patients follow the directions of teacher and doctor closely. Of course, there are those who aren’t as successful. For these, the outcomes are not always so good.