Patient Engagement
Stay in Your Lane? Clinicians vs. SDOH (05:19)

Should physicians stay in their lanes when it comes to things like behavior change and social determinants of health (SDOH)? Or do they have a duty to reach out beyond clinical work?

“I appreciate the thoughts of staying in your lane,” says Duke adolescent medicine PCP Charlene Wong, “but in my own clinical practice, I can’t do that.” A big part of Wong’s job is talking with patients about their social history to pinpoint the emergence of risky behaviors. “I see it as a huge opportunity to intervene at a critical point and life stage,” she says.

Wong appreciates having other team members with social and behavior expertise available, too, such as at a Medicaid clinic she works at. “They’re not available all the time; they’re covering a huge panel of clients themselves,” she notes. “Until we’re able to have some more of those teams that are in place, consistently, I see my role as doing that.”

Stepping outside one’s lane is particularly importantly when connecting people with behavioral health care. “A lot of my patients are struggling with depression, anxiety,” says Wong. “If you’re not able to work on that simultaneously [e.g., with physical activity], the sustaining of any change you’ve achieved is going to be much harder.”

Roy Rosin, Chief Information Officer for Penn Medicine, says that physicians should stay in their clinical lane and let other experts do the non-clinical work.

Rosin describes Shreya Kangovi’s IMPaCT initiative, which identifies, hires, trains, deploys, and manages community health workers. The populations IMPaCT serves have poor relationships with the health care system, says Rosin. They are more likely to interact productively with people from similar backgrounds. “What these community health workers do is remove friction,” he says. “They understand [not only] what are those goals, but what’s standing in the way of those goals — how do we get rid of those things?”

“There is absolutely no way that the clinician can, in the period of time allotted, manage [patients’ SDOH needs],” says Rosin. A patient may not be able to deal with their health until they have stable housing, for example. Community health worker programs like IMPaCT can successfully intervene here; a clinician cannot. “Friction that has to be removed from the system goes well beyond the clinical setting,” says Rosin. “It’s so much work.”

Peter Ubel, Associate Director of Duke Health Sector Management, adds to Rosin’s point that clinicians have limited time. “In the 15 minutes you’re with a patient, you have to maximize what you can do for them, given your background and your abilities, and you want to work with a team of people who can help complement what you can and can’t do best,” he says. However, he believes physicians should be in multiple lanes.

“As physicians, we’ve gained insights into parts of humanity and society, and we’ve got esteem, respect, money, and power,” says Ubel. “If we’re just staying in our lane and thinking 15 minutes at a time with patients” rather than using that status, then that’s not enough, he says.

Ubel mentions pediatrician Jill McCabe, who ran for state office. “Why did she run for office? Because she saw what lack of Medicaid coverage did to her patient population,” he says. “That jumping out of a lane I’d really like to see. And when we’re in our own lanes, we can share the lane with a lot of other people, too.”

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