practice partner
own health. Many patients, in fact, are or
certainly want to be. One question – does
the health care provider encourage or discourage involvement?
Six keys to grow engagement
Stephen Wilkins writes about this often
on the blog of his health communications
company. Wilkins, who lives in San Jose, is
a former hospital executive and consumer
health behaviour researcher. He notes that
by the time someone sees a doctor, they are
already engaged in their own care to some
extent.
Perhaps they’ve taken action to try to
resolve a health issue or reverse a problem.
Maybe they’ve sought solutions from other
health-care professionals or resources. They
may have talked about their need or concern
with family and friends. Just the mere fact
of seeing a doctor, and getting a mental list
of questions ready, also demonstrates some
basic awareness.
All of that shows a level of engagement
– but it’s not necessarily enough. Here’s
what Wilkins writes: “What happens in the
doctor’s office plays a big role in determining whether the patient’s level of engagement
grows, or is diminished if not extinguished.”
So what should occur during that visit?
Wilkins talks about “creating an atmosphere
that facilitates, cultivates, and builds upon
the level of engagement which patients
bring”. He and other experts in doctorpatient communications mention six keys:
1
Explore the agenda. Ask patients for their views and feelings. How
do they see the health issue at hand?
What do they feel is at the root of their problem, and what do they want you to do for them?
What do they worry about? Hope for? Use
words that show your empathy and support.
2
62
Dialogue Issue 4, 2014
Stay in the moment. Take the time
to actively listen. Make the patient in
front of you your sole priority.
Confirm clarity. Don’t only welcome questions, but specifically and
frequently ask for them. Have patients
repeat back in their own words what they’ve
heard, to explore any gaps in understanding.
3
Discover what matters most.
Explore the patient’s fundamental
beliefs and values, and where
possible honour them. Probe their past
health experiences. Learn how much, or how
little, patients want to be involved in decision-making.
4
Be a teacher. Educate patients,
about their ailment/condition, the
different health-care roles that may
come into play, and navigating the system (if
applicable). Explain the reasoning behind
any tests, treatments and medications.
5
Get on the same page. What are
the patient’s health goals, and what
do they think they and you can do to
achieve them? Ensure understanding of the
diagnosis, treatment and plan of care. Are
they in agreement?
6
Doctors who can do that, says Wilkins,
demonstrate traits that encourage patients
to be even more involved in their health.
“Physicians who appear rushed, not present, not prepared, or who fail to solicit the
patient’s input,” he writes, “often have the
opposite effect.”
It’s about doctor engagement
To spur positive health behaviours, increased
satisfaction and better outcomes, the issue
isn’t just patient engagement. It’s also doctor
engagement.
When it comes to being knowledgeable
about their health or interested in their care,
not every patient is at the same place. The
doctor’s attitudes and actions can have a lot to
do with that.
To be sure, other forces are at work in driv-