Picture the patient Harold as a long-haired, straggly-bearded street man in Salt Lake City. That’s how the staff at Intermountain Healthcare’s emergency department, where Harold presented regularly, saw him. And then some: alcoholic, intimidating and abusive.
Intermountain’s corporate director of patient and clinical engagement Tammy Richards did not specifically state that doctors and nurses were afraid of the homeless man, but the implication was palpable.
Until one day a nurse sat down with Harold and talked to him as a person — before having him shed his own clothes to don a hospital gown for a cold, prodding examination — and learned that Harold is an Afghanistan war veteran wherein he both witnessed and participated in violent acts, including some against women and children, that have had haunted him ever since.
“That day when he told his story, Harold changed,” Richards recounted here at the Healthcare IT News Patient Engagement Summit. “And so did we.”
Forgotten history
Harold’s is just one of literally countless stories about caregivers who do not fully understand the patient as a whole person.
Indeed, it may even be becoming more common as hospitals shorten time spent with patients from what Patricia Salber, MD evoked as “the tyranny of the 15-minute office visit,” down to 8 minutes or fewer.
“I think one of the things we’ve dropped is the social history, the personal story of a patient,” said Salber, CEO of Health Tech Hatch and The Doctor Weighs In.
Yet that personal past is perhaps more important now than ever — as is, of course, the present.
“People really, really prefer the present over the future,” said Douglas Hough, associate director of the Master of Healthcare Administration program within Johns Hopkins University’s Health Policy and Management Department.
That rationale figures prominently in what Hough discussed as the fast-brain vs. slow-brain modes few people have mastered. As in: the fast brain just lights up a cigarette even though the slow brain doesn’t actually want a smoke because it understands the body will likely live longer without one. Same goes for sugar cookies.
Tech tools lacking
Patient engagement sounds great in conference halls, to be certain, but it is not as easily achieved inside and outside of hospitals. Among the reasons: despite the hailstorm of apps, devices, sensors and wearables all generating massive amounts of patient data, practicable tools for doctors to glean meaning from that information are few and far between. And the ones geared toward physicians are rarely designed with patients in mind as well.
As director of Geisinger’s eHealth clinical innovation division, Chanin Wendling has spoken with many a vendor boasting of its patient engagement tool. But she makes no apologies about the uncomfortable conversation that ensues once she starts asking to see a patient profile page, or to look at what patients can select within the software, how they receive notifications, timeframes, and the list continues.
“They just sort of look at me,” Wendling chuckled. “They really have no good answer and, after I swear quietly under my breath, I tell them they don't have a patient engagement tool.”
And when Wendling expounded that “if all we’re doing is talking to the clinical teams we’re never going to design a solution that actually works,” many faces in the conference’s crowd lit up and heads nodded in agreement.
The potential of neuroscience
Neuroscience is neither a new study, nor one commonly tied to patient engagement thus far. Perhaps it’s time to change that as the need for doctors and patients to better understand each other becomes increasingly lucid, if not obvious.
In her opening keynote, Kyra Bobinet, MD, CEO and founder of startup behavior design firm engagedIN and consulting faculty for the neuroscience of behavior
change at Stanford’s School of Medicine, stressed the clear and present need for doctors to consider the art and science of the human brain’s interminable complexity.
Bobinet’s phraseology encompasses terms including self-image, gain vs. loss, tension, crisis, suffering, triggers, giving, playing and seeking.
The overarching challenge is to reengineer the patient-doctor relationship based on a deep understanding of those emotions at play in each individual by taking into account, for instance, that “human brains are much more sensitive to losing than gaining … so doctors could get an adoption curve across a population.”
But while emotion is one of the strongest levers in existence, Bobinet said that fear will only work once, and triggers only until the brain comes to realize how it is being preyed upon, which is why Hough called for giving patients “a default into the flow of things.”
That can be as simple as rearranging a pediatric visit to administer the vaccine shot first, then spending the rest of the time holding the child and doing less stressful pieces of the exam, thus ending the appointment on a better note than sticking them with a needle and walking out the door.
Or it can involve making connections between patients to enable them to help each other exercise, spend more time with their kids, or quit smoking, all the while playing on the brain’s desire to give — which Bobinet contended is a powerful attention-holding tool particularly when a patient is not taking from another but, instead, being in a position to literally help someone else.
“If you want to get patients engaged,” Hough suggested, “you get them engaged when they don’t know you’re doing it.”
