Patient engagement: Are docs doing it all wrong?

'We're not taught as clinicians or people in the industry to change behavior'
By Erin McCann
09:41 AM
Kyra Bobinet

Real patient engagement is far more than patient portals and technology pushing. It's about changing behavior, both on the patient and provider end – and that's not something all docs do well. But as Kyra Bobinet, MD, health engagement instructor at Stanford University's Behavior Design Lab, sees it, that's not the fault of the clinicians.

[Learn: Patient Engagement Summit]

We caught up with Bobinet, who will be joining 35 other industry thought leaders to speak at the HIMSS Media and Healthcare IT News Patient Engagement Summit this February, to hear more about how she thinks the industry should move forward with patient engagement – what she see as a game changer for the healthcare industry – on a broad scale. A hint? More holistic clinician training and a psychology refresher will go a long way.  

Q: What will you be talking about at the Healthcare IT News Patient Engagement Summit?

[See also: Patient engagement means 'attitude adjustments' on both sides]

A: I'll be presenting my take on why there's this gap between what people say they want to do and what they mean to do and what they actually do, which is vexing the entire industry. I started out as a physician. I started a nonprofit that was aiming to change behavior…and then went to public health because I was so fascinated with this concept of we're not taught as clinicians or people in the industry to change behavior, and we also struggle to understand what's going on, so what I want to do is give the audience a real sense of why people do what they do and how they can help them in tangible terms, not just theoretical, but 'here are the patterns of behavior to look at, here are certain concepts of how people operate.' We'll cover a little bit a neuroscience, a little bit of holistics, a little bit of case studies to really illustrate how to get at this.

[See also: For portals, speak patients' language]

Q: You're interested in the specific relationship between psychology and neuroscience and the engagement piece. As a physician, what has been your experience with that?

A: I think that the patient that inspired me to go in the direction of this conversation was a gentlemen who had gout, and I was talking to him, writing a prescription, and he just dropped, as patients often do because you have 10 minutes with them; they wait for the juiciest thing to drop on the very last minute and then run out the door, but I was saying, "How did this come about? How did this happen?" And he said, "Oh, well, I did meth three days ago and haven't been the same since," so essentially he was dehydrated from doing meth, which caused the toe, which caused the prescription. So there's whole data chain of "This becomes that." For me, I just landed here by asking a question: "What is the difference between what I'm seeing people say and then what they actually do?"

Q: How do you move forward with patient engagement to the point where improvements are actually observed, knowing that clinicians have often been struggling in this arena?

A: I think physicians do want to change behavior. Everybody I've ever known really cares about serving people; that's why they go into that profession because if you don't really care, you don't last very long.

So what happens is that you develop disappointment, and you get discouraged because you're kind of at the 'gouty toe end of the equation,' and you have all this other stuff upstream, and you have time limitations; you have these scope limitations. Your role is limited. … I think if you are to contend with that feeling of helplessness, we as service providers or people who are servants of others or clinicians just develop some coping mechanisms, so I would say it's not that they don't want to change behavior; it's that they've never been trained. It's not part of the medical education process for essentially any healthcare provider. I think for right now, what is being called for industry wide is how to bring that skill set into the mainstream, how to include that as part of the entire system, whether you have a technology, whether you have a hospital, whether you are a direct service provider clinician yourself, I think across the board, people are asking this question of how can they support and be good at this skill set.

I would say my one commentary is: "It's time.'' … I think there is a confluence of interest, need, incentive and value that comes from being able to achieve this. … Everywhere I go, people really care about this, and they really want to see it happen, whether they are a patient with multiple conditions, and they're frustrated, or they're a service provider, or they're a technologist. It seems like there's a group of people that I'm hoping will create a flashpoint of not hand waving kind of change, but actual – if they knew what to do and they knew how to approach it, they would actually change the world.