Patient Engagement
Clip
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
Many Barriers to Engaging Patients in Treatment for Obesity

Survey Snapshot: Approaches to Address Clinician and Societal Roles in Obesity

The obesity problem is getting larger and larger. Some solutions lie beyond the traditional medical setting.

Esch01_pullquote patient activation

OpenNotes, Patient Narratives, and Their Transformative Effects on Patient-Centered Care

The development of standardized tools and techniques are enhancing the ability of providers to interact with patients, but true patient engagement requires a common understanding of its theoretical foundation and an open mind for including patients’ needs and beliefs — in their language — as part of each encounter.

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.

Connect

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

Learn More »

Topics

OpenNotes, Patient Narratives, and Their Transformative…

The development of standardized tools and techniques are enhancing the ability of providers to interact…

Care Redesign Survey: Lessons Learned from…

Although care delivery models in rural and urban/suburban areas are distinct, by virtue of geographic…

Care Redesign Survey: Lessons Learned from…

Although care delivery models in rural and urban/suburban areas are distinct, by virtue of geographic…

Insights Council

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

Apply Now