My Favorite Slide: When Patients Are Prevented from Engaging

We’re constantly told patient engagement is the next blockbuster drug, and, for the record, I agree. But what does that really mean, and how do we get it? The best definition I’ve heard comes from the Center for Advancing Health, which says that patient engagement is the “actions individuals must take to obtain the greatest benefit from the health care services available to them.” That means engagement is about action: patients doing what they can to take command of their health.

That reminds me of a study I read when I was a medical student at the University of Chicago. Researchers observed dozens of primary care visits and simply measured the amount of time patients spent waiting, listening, and talking. The results suggest that even when patients want to engage, physicians don’t often let them: patients spoke, uninterrupted, an average of 12 seconds after the resident entered the room, and in 42 minutes the patients spoke for a mere 4 of them. What’s to be done about this lack of engagement?

At Oak Street Health, our network of primary care practices for low-income older adults in the Midwest, we’ve certainly invested in longer and more frequent visits, with the goal of creating more time and space for engagement to occur, but we’ve also encouraged teams and physicians to generate opportunities for patients to engage by being active listeners in the exam rooms. To be active listeners, we focus on removing the computer from the physical space between physicians and patients using highly trained medical scribes (a.k.a. “ninjas”), on asking open-ended questions that encourage patients to explore the limits of their knowledge, and on repeating our patients’ own words back to them so we can confirm understanding together. It’s far more important for our patients to address their gaps in understanding than it is for physicians to bill a complete, 10-system review of systems.

This slide originally appeared in NEJM Catalyst on June 8, 2016.