Patient Engagement
The Importance of Patience with Patients (03:06)

How do clinicians work with patients who come in time and time again with uncontrolled diabetes, for example, but they won’t follow the health provider’s recommendations?

“There’s a bit of a proactivity involved in this, that if the patient comes in with a problem you feel like you have to do something about it,” says Victor Montori. But whatever clinicians do or suggest must make sense to the patient in that particular context, he says. You might write down your recommendation in the patient’s medical record and give yourself a gold star because you felt like you did something, but you didn’t really do anything if the patient left and nothing happened.

“The issue is, at least with chronic conditions, that many of the things we’re alarmed by won’t have a consequence immediately; we have time,” says Montori. “If we could build within the relationship the opportunity to make smaller changes, try figuring out together what to do, and demonstrate that you really mean it — that ‘you’re allowed to fail, and I will be with you if this doesn’t work’ and ‘if it doesn’t work, I have five other tricks we can try’ — then you will make progress.”

Montori mentions that some of his patients whom he has followed for the past decade are only now beginning to show evidence that they are better off than 10 years ago. “I’m not going to move in with the patient, but sometimes you probably feel like you want to be with them until the day where it all clicks,” he says. “And then when it happens, when it all clicks, of course the temptation is to think that you’re a genius, that you made it happen, but it’s actually the patient who made it work, and it just made sense, and it probably took 20 or 30 tries.”

In other words, clinicians need to have patience.

Kathryn Pollak shares an example from one of her colleagues, a kid who had ADHD and smoked pot. The clinician wanted his patient to quit smoking, but he refused. So the clinician asked if he could bring it up next time, and did. During the next couple of sessions, the patient continued to say no. But by the fourth session he said, “You know what? I think I’m going to consider stopping doing that.” The clinician, shocked, asked why. The patient’s response: “You didn’t force me. You let me come to it on my own terms.”

“That was critical, because our tendency is if they’re not doing something we want, we keep pushing, we keep pushing,” says Pollak. “All that does is put patients on the other side.”

From the NEJM Catalyst event Patient Behavior Change: Building Blocks for Success, held at Duke University, April 4, 2018.

More From Patient Engagement
Ghafur01_pullquote -digital health health care consumer patient experience

Engaging Patients Using Digital Technology — Learning from Other Industries

Providers can benefit patients and disrupt health care by learning from the experience of other industries.

Mission Hospital Virtual Sitter - Drawing of the Virtual Bed Zone and Rails

Reducing Inpatient Falls and Injury Rates by Integrating New Technology with Workflow Redesign

How Mission Hospital scaled a virtual sitter pilot and reduced unassisted falls by 44% and fall-related injuries by 40%.

Health Care Providers Should Incentivize Patients

Survey Snapshot: Patient Financial Incentives — There Are No Quick Fixes

The NEJM Catalyst Insights Council agrees that while financial incentives are a common strategy to engage patients in healthy behaviors, they are not necessarily effective.

Support of Family and Friends Is More Effective Than Clinician Support in Realizing Health Goals - From the Patient Engagement Insights Report: Why No Single Health Incentive Works.

Patient Engagement Survey: Why No Single Health Incentive Works

Initiatives to improve patient engagement come in a variety of forms. While insurers, employers, and health care providers are all involved in using financial incentives and penalties for engagement efforts, improvement in health outcomes has been elusive. Achieving that ultimate goal will usually require a combination of financial and social approaches.

Health Systems Attending the Nudge Units in Health Care Symposium - Penn Medicine

Key Insights on Launching a Nudge Unit within a Health Care System

Leaders are finding that making higher-value choices easier through subtle changes to choice architecture can have an outsized impact on medical decision-making.

Barriers to Providing an Oustanding Patient Experience

Buzz Survey Report: Patient Experience

An independent NEJM Catalyst report sponsored by University of Utah Health on barriers to achieving an excellent patient experience.

The Patient Engagement Capacity Framework

The Patient Engagement Capacity Model: What Factors Determine a Patient’s Ability to Engage?

Patient engagement assessments often don’t dig deep enough to identify why patients don’t participate in their own health care. We present a new model to help providers pinpoint the reasons for lack of engagement and address them more effectively.

Organizational Mindset Is the Biggest Barrier to Engaging Patients as Consumers

Survey Snapshot: The Patient-Physician Relationship Is Key

Both parties involved in a consumer-facing transaction have access to important information about the product or service — but this isn’t the case with health care.

What High-Need, High-Cost Patients Say About How to Reduce High Utilization of ED and Inpatient Services

High-Need, High-Cost Patients Offer Solutions for Improving Their Care and Reducing Costs

More home health care and after-hours clinics, telemedicine, and home delivery of medications are among top solutions.

Top Physician Pain Points Identified by Chronic Patients

Unmet Needs: Hearing the Challenges of Chronic Patients with Artificial Intelligence

With natural language processing and machine learning, researchers are identifying patient emotional and medical needs that are not being met by clinicians and patient advocacy groups.


A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »


Angel Robot and a New Smart…

The Jingde Experiment’s Angel Robot illustrates how continuous, closed-loop learning symbiosis between doctor, AI, and…

Creating “One-Stop Shop” Care for Parkinson’s

Integrated Practice Units (IPUs) can revolutionize the care of specialty disease conditions, and Parkinson’s disease…

Patient-Centered Care

269 Articles

No Place Like Home: Bringing Inpatient…

Providing home-based acute care improves patient satisfaction and care quality while reducing costs.

Insights Council

Have a voice. Join other health care leaders effecting change, shaping tomorrow.

Apply Now