In early 2015, I met a new patient in my primary care practice: a young man who was struggling with his weight, rarely exercised, and smoked a pack a day; was so stressed about his job and finances that he was starting to have weekly panic attacks at work and wasn’t sleeping well; and had recently been diagnosed with hypertension by his previous primary care provider but had a difficult time taking hydrochlorothiazide each day. It was a busy visit. He was overwhelmed by life and unengaged with his health.
We talked about his health goals and the many obstacles he perceived. I offered some guidance, told him I was glad to start working together and that I cared about his health, and together we decided on a plan of reachable next steps. When we shook hands and looked each other in the eye at the end of the visit, I felt hopeful about the path we were starting down.
Because we had discussed so many active issues, the plan was for him to return to my office in a few months to check on his progress. Unfortunately, he missed the three-month follow-up visit and didn’t respond to our calls to schedule another, so I moved on. I was disappointed, but soon forgot about him after that promising first visit.
A year passed, and then one day a few weeks ago the man’s name showed up in my clinic schedule. The appointment arrived, and in the moment before I knocked on his exam room door, I braced for impact — a year’s toll of unchecked health problems awaiting me. But as I stepped into the room, he energetically rose to greet me. He looked twenty pounds lighter and was smiling brightly. We sat down and started talking, and I’ll never forget the ten minutes that followed. He had stopped smoking. He was walking to work, two miles each way. He was meditating during his lunch hour and before bed, and now slept at least eight hours a night. He rarely felt anxious. He had bought a blood pressure cuff and noticed that his numbers had fallen to the normal range, so had long ago stopped his medication. A completely different man from the patient I had first met sat before me.
After learning about his multi-front progress, I asked him, somewhat shocked: “How did you do this?” His answer was brief but spoke volumes: “I started to care and believe I could change. I saw results that made me feel good. I found a way forward that worked for me.”
I often think about this patient during the course of my week, sometimes when I’m seeing other patients, but mostly during the time I spend as a medical director for the Brigham and Women’s Physicians Organization, and for the Population Health Management team at Partners HealthCare. In these roles, I work on our system’s patient engagement programming — a broad set of tools to help patients become more involved and informed in their care.
The premise is simple, but among the most complicated to achieve in health care: to succeed in the transition to population health and alternative payment models, we need to help change the behavior of our providers, our care systems, and most importantly, our patients to achieve better health outcomes.
The patient described is, of course, in the minority; indeed I have no others like him. He was able to make significant changes in his health almost entirely without the support of health care professionals. But coded into his explanation for his progress are some of the goals I believe health systems like ours should work to distill and crystallize into scalable programs to better engage populations of patients in their care:
- Supporting behavior change (“I started to care and believe I could change.”)
- Enabling tools for self-care (“I saw results that made me feel good.”)
- Tailoring our approaches to unique population segments (“I found a way forward that worked for me.”)
Some people will reach similar outcomes without health care interventions. For those patients who need support in achieving good health, however, our patient engagement programs seek to enable and replicate the kind of behavior change my patient stumbled upon himself. As tempting as it is for providers to themselves seek the elixir to patient engagement — Was it our eye contact at the end of the visit? Or that I told him I cared about him? — the reality is that patients spend most of their time away from us, so they need interventions that follow them outside of care settings. Their health is more about them than about us.