Patient Engagement
Clip
The Physician’s Role in Improving Patient Behavior (05:28)

What’s the role of clinicians, particularly physicians, in steering patients toward behavior change? Should they be cut out of the loop? Or is there potential synergy with the patient?

“The clinician plays a vital role and probably an increasingly vital role the more complicated and dire the health circumstances are,” says Katherine Baicker. If a patient needs bypass surgery, for example, they can’t determine the best type of procedure and where to go for that procedure and rehabilitation on their own. She adds that health reforms are empowering physicians to play more of an active role in patient steering, and that patient incentives and physician incentives can work hand-in-hand to promote good steerage through the health care system.

After all, physicians are subject to the same behavioral biases that patients are when it comes to making decisions, Baicker says. “The variation across physicians tells us that there are some things that some people are doing really well that maybe could be adopted by other people,” she explains, “and learning what those techniques are beyond the walls of the health care system, I think is one of the most promising avenues for harnessing those social determinants, and the physician is in a good position to do that.”

“I think we’ve never needed physicians more,” says David Asch. “People trust physicians, and trust is an incredible social lubricant that reduces the transaction costs.” Messaging from an insurance company or employer might leave a patient cynical, but when that same message comes from a doctor, its meaning changes. “We can develop perhaps the right message, whether that is an educational message or a behavioral approach, but the messenger is incredibly important in that,” says Asch, emphasizing how important it is for patients to harness their existing trust relationship with physicians and nurses for optimal benefit.

Niteesh Choudhry makes the distinction between diagnosis and treatment recommendation, and treatment delivery. Just because the physician is a “trusted lubricant of the delivery of what needs to be done” doesn’t mean that they need to be the deliverer of it, he says, adding that sometimes physicians do a “particularly bad job.” If someone who comes to an appointment has poorly controlled diabetes, for example, the result might be the physician delegating the tasks by sending that patient to a number of specialists. “Taking us out of the loop is probably not the right answer,” says Choudhry, “but also relying on us to do all of these things is probably not the answer either.”

From the NEJM Catalyst event Patient Engagement: Behavioral Strategies for Better Health at the University of Pennsylvania, February 25, 2016.

More From Patient Engagement
PROMs Usage Is Limited but Growing

Patient Engagement Buzz Survey: PROMs Use Is Growing, but Implementation Takes Effort

While clinical outcomes lend themselves to measurement, quantifying how an individual patient experiences symptoms or a loss of function can be more challenging. One promising approach is the use of Patient-Reported Outcome Measures (PROMs).

Taxonomy of the Patient Voice Table

Taxonomy of the Patient Voice

While health care pursues the important trend of putting patients at the center of care, the terms used to describe this goal are proliferating — and muddying the discourse. This taxonomy attempts to classify some of these terms and make some distinctions.

Agarwal01_pullquote handcrafting the patient experience

Handcrafting the Patient Experience

Health care organizations can take cues from consumer-facing companies like Airbnb to creatively insert convenience and surprise into patient encounters.

Screenshot of Tidepool daily diabetes data

A Taxonomy to Engage Patients: Objectives, Design, and Patient Activation

Health information initiatives will succeed only if they focus on patients’ motivation to engage and reflect the type of engagement they seek.

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.

Connect

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

Learn More »

Topics

Patient Incentives

75 Articles

Taxonomy of the Patient Voice

While health care pursues the important trend of putting patients at the center of care,…

Ripe for Disruption: Why and How…

For big tech companies like Amazon, Apple, and Google, the health care sector looks ripe…

Patients As Customers

141 Articles

Information Asymmetry: The Untapped Value of…

The knowledge and preferences that patients could — and should — share with clinicians would…

Insights Council

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

Apply Now