Patient Engagement
Clip
Leveling the Clinician-Patient Playing Field (03:05)

How do we level the playing field for patients and clinicians to enable shared decision-making? Social psychologist Kathryn Pollak asks two experts in shared decision-making, Angela Fagerlin and Victor Montori, for concrete examples.

Many times, the situation is emergent and leaves little room to prepare, says Fagerlin. Yet preparation is crucial for improved shared decision-making and should be worked in wherever possible.

Fagerlin describes how a former colleague would give prostate cancer diagnoses over the phone. When she learned about this practice, Fagerlin initially thought it unethical. But over time, she saw its value. Calls were scheduled in advance so that patients weren’t caught off-guard, and the person calling had done the biopsy.

“They had a relationship with the doctor, it wasn’t an MA calling, and they were prepared for the call,” she explains. “They got to think about it. They got to do the reading and talk to their friends. So when they went to see their doctor for the first time [they were ready to make a decision].”

“If we wait until that appointment to get people prepared, it’s probably not going to work because they’re not going to ask questions or have preferences,” she says.

Montori suggests leveling the playing field in a physical way — where clinicians position themselves when talking to patients. “Recognize that for the clinician this could be a routine, and for the patient it will be a shock and it’ll be a new thing,” he says. “The clinician has to do the heavy lifting of that balancing of the power. Sometimes people talk about how patients have to come in empowered and ready. It’s just very unfair to demand that from people, and I think it’s better to demand that from the clinician,” he says.

He describes one approach that works for him: sitting on the floor.

“I’m a diabetes doctor. I examine feet a lot, and so I usually have some important parts of the conversation when I’m [on the floor],” he explains. “It really puts the patient in a much different position and perhaps a better position to have this [conversation].”

Avoiding jargon is another way to level the playing field. “When pressured by time, we’ll go back to our shorthand, and our shorthand involves a lot of jargon. And jargon is one of the subtle ways in which we establish our power,” Montori says. “Being mindful of that and creating spaces where we don’t feel rushed so that we don’t fall back into our shorthand, that may help.”

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

More From Patient Engagement
Patients and PCPs Hold Primary Responsibility for Addressing Obesity

Patient Engagement Survey: The Failure of Obesity Efforts and the Collective Nature of Solutions

Patients hold responsibility for their actions, but providers’ approaches to address obesity often fall short as well.

Items from the Shared Decision-Making Process Survey for Elective Surgical Procedures - patient decision aids - decision quality - informed consent

Shared Decision-Making: Staying Focused on the Ultimate Goal

Despite growing acceptance and enthusiasm for patient involvement in their health care decisions, clinicians, at times, lose focus on the ultimate goal of shared decision-making: better health decisions from the informed patient’s perspective.

Kangovi01_pullquote community health workers boom

The Community Health Worker Boom

Practical insights that can help organizations optimize their investments in community health workers.

MD Anderson Cancer Center PAAC Health Information Data Before and After Implementation of New EHR System

Using a New EHR System to Increase Patient Engagement, Improve Efficiency, and Decrease Cost

The University of Texas MD Anderson Cancer Center saw active participation from patients by encouraging them to document their own health information into a new EHR.

Phrases That Enhance Physician-Patient Communication for Scripps Health Hospitalist Groups

Improving Hospitalist Patient Experience Scores: The Importance of Physician-to-Physician Coaching and Medical Director Engagement

With the Centers for Medicare and Medicaid Services incorporating patient experience into Value-Based Purchasing metrics, hospital leaders must focus on improving this important aspect of patient care.

DLewis01_pullquote Opening Up to Patient Innovations Like Automated Insulin Delivery

Opening Up to Patient Innovation

Next-gen innovations — by new stakeholders — will need a next-gen regulatory system, and clinicians willing to adapt.

Karen DeSalvo - public health population health social determinants of health expert social services infrastructure

Moving from a Sickness Model of Health Care to One of Well-Being — Part 2

A public health expert discusses the scientific, technological, and financial foundations needed to modernize the social services infrastructure and address social determinants of health.

PROs Associated with Better Top-Box Satisfaction Scores at UPMC

Better Physician Ratings from Discussing PROs with Patients

A UPMC study demonstrates the value of PROs, but finds that physicians need to discuss that information with patients during visits.

Karen DeSalvo - public health population health social determinants of health expert social services infrastructure

Moving from a Sickness Model of Health Care to One of Well-Being — Part 1

The expense of the U.S. health care system is so misaligned from what we need as a country — a healthier population. A public health expert discusses how we can move toward a model that addresses social determinants of health and promotes well-being while still growing our economy.

Different Means of Initiating and Sustaining Behavior Change

Survey Snapshot: Social Support, Whether In-Person or Virtual, Is the Key to Sustained Behavior Change

NEJM Catalyst Insights Council members seek ways to create relationships with patients — but the hurdles are high.

Connect

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

Learn More »

Topics

Stay in Your Lane? Clinicians vs.…

Should physicians stay in their clinical lanes when it comes to behavior change and social…

Patient-Centered Care

233 Articles

Patient Engagement Survey: The Failure of…

Patients hold responsibility for their actions, but providers’ approaches to address obesity often fall short…

Patient Incentives

66 Articles

Patient Engagement Survey: The Failure of…

Patients hold responsibility for their actions, but providers’ approaches to address obesity often fall short…

Insights Council

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

Apply Now