Patient Engagement

My Patients Won’t Do What They Are Supposed to Do

Article · January 27, 2016

The standard physician response to being judged on quality data that shows disappointing health outcomes is “My patients are sicker.” Increasingly, I am hearing that quote being replaced by another: “My patients won’t do what they are supposed to do.”

Both comments may seem an all-too-human, reflexive attempt to deflect responsibility for health care improvement. But my take is that the new phrase reflects a positive shift — that we are moving toward a health care system in which performance really matters.

First, I should make clear that I have said both of these comments in my role as a practicing physician, and I have heard both in my role as a health care manager. “My patients are sicker” is the traditional reaction to data showing worse mortality, higher rates of hospitalization or readmission, or greater use of emergency departments. Physicians who are working as hard as they can work know that these poorer outcomes cannot be their fault. Their logical conclusion has been that the data do not capture the ways in which their patients are at greater risk for bad outcomes.

Today there are more and better data available to adjust for differences in patient populations, but statistical advances are not the only reason why the second physician response is increasing. I think physicians are reacting to the larger trend of patient engagement.

The spotlight has shifted from provider reliability to patient outcomes — the improvement of which is, after all, the real goal of health care. This means the goal of performance analysis is not to judge providers, but instead to assess what is happening to the health of their patients. And if the answer to that question is “Not much,” clinicians have some explaining to do.

It’s natural for physicians and other providers to note that their patients are less than reliable in taking medications, in losing weight, in exercising, in giving up cigarettes, in reducing their intake of alcohol. That is why clinicians now say, “My patients won’t do what they are supposed to do.” But after that understandable reaction, their focus should turn to helping patients do the things they are supposed to do. Working with patients to achieve better health is the essence of patient engagement. The physicians and organizations that understand this will be most successful.

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