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.