Asking physicians to establish human relationships with their patients makes them vulnerable — not something many are comfortable with. “What’s the ‘what’s in it for me?’ to be vulnerable and establish these relationships with my patients so that I know them on the street and they know me on the street?” asks Wendolyn Gozansky.
“In traditional fee-for-service primary care practices — [when] you have 15 minutes to see a patient — we suffer what can only really be described as a moral injury sometimes,” says Toyin Ajayi. This is particularly true with patients whom you know will come in with such a long list of problems that it’s impossible to know where to start, and even if you’ve had the same conversation with that patient every year, multiple times a year, it’s possible nothing has changed. “Every time you see that dot appear on the schedule and you know that patient has arrived, your heart sinks a little bit,” says Ajayi. Nothing has changed because you lack the resources to actually deliver the care that patient needs.
“I’m not saying go in there and make yourself vulnerable in the absence of structures to support your actually being able to deliver care,” explains Ajayi. “It’s a combination of building the systems and the teams that allow you to act on that information and allow the provider to not have to hold the entire weight of addressing all of the issues for the patient, but still gives them the space to have that conversation.” For example, a provider could ask a patient about housing or meal plans if they know that a member of the care team specializes in connecting patients to what they need.
“The physician doesn’t have to carry the full weight of every single interaction with every single patient and attach to every single patient in that regard,” adds Nirav Shah. He tells the story of a receptionist who convinced a patient to get a colon cancer screening, something no one else on the team had succeeded at. “Now that receptionist wears a pin that says ‘I saved a life,” says Shah, “and she connects like no one else. That’s the kind of attachment to a member of the team, even if it’s the receptionist, that changes, ultimately, the outcomes that matter.”
From the NEJM Catalyst event Hardwiring Patient Engagement to Deliver Better Health at Kaiser Permanente Southern California, April 13, 2017.