Paths to Improved Patient Engagement

Feeling Calm, Cool and Collected: A Vital Foundation for Effective Patient Engagement

calmpatient_doctor_resizedthinkstock-498884524Emotional well-being is not easy to measure, especially when compared to an improvement in blood sugar or blood pressure. Yet, I’m struck by how often patients use the adjective calm when describing health situations, explaining why they like their provider’s demeanor or wishing there was respite in a crisis.

Calm need not connote ignorance, avoidance or even worse, over-medication. Rather, it signals an ability to absorb information and move forward as an empowered, proactive patient. Feeling anxious, nervous, unsure, panicky and vulnerable makes hard health decisions even harder.

A few mental health indicators like the MHI-5 ask directly about feeling calm or peaceful. But in the hubbub around mindfulness interventions and building soothing spaces into healthcare designs, I’m surprised how little has been done to measure when and how to help patients feel assured and pulled together. (And if there are overlooked measures out there, please comment and tell us about them!)

Where Anxiety Prevails

I am all too aware that providers don’t get patients to calm very well. A survey conducted at Consumer Reports in 2013 asked parents and guardians of children with ADHD what was true for them immediately after receiving the ADHD diagnosis for their child. And while they left with a diagnosis and often with a medication, under half (45%) found a healthcare professional to contact with any concerns, and only 31% had a clear plan of action for going forward. Nineteen percent were more worried than before the diagnosis. While to some degree this could measure greater awareness, this state of mind could also get in the way of a productive coping process. If health systems are to further improve patient-centered care, they need to identify and track specific confidence gaps like these, determine where they frequently occur, and minimize them.


Striving for Calm

Engaged patients, on the other hand, understand the need to stay informed, ask questions, question assumptions and advocate for the care they want — great strategies I’ve followed myself and suggested to others. But do they lead to calm, confident and collected patients? I’m not so sure. In fact, such steps might heighten our emotionality or even make us angry during a provider encounter. Strong emotions often accompany the stresses and pains of being sick, being a patient or being a caregiver for a patient. Patients shouldn’t feel a need to apologize for or regret expressing such emotions. That said, empowered patients may find staying calm more helpful than an internet search. And calm is something that patients and providers can work to achieve together.


When I was still working for Consumer Reports managing health surveys, we’d often ask patients (and providers) what they’d recommend to others. Three prominent examples that arose were:

  1. During doctor visits, take notes and/or bring someone with you.
  2. Build personal rapport with your doctor. (Example: be sure to meet the surgeon before the surgery or know something about the personality of your new primary care doctor)
  3. Know the timeline and expectations for recovery.

Helping Patients Navigate Uncertainty

Doctor Listening to Patient Talk About Her Medical SymptomsWhile our data don’t show convincingly (Media pollsters typically don’t test theories or mechanisms), common sense suggests these actions work because they help patients navigate uncertain terrain in a calm, confident and collected manner. Quality improvement professionals can identify and track actions like these that lead to composure and also pinpoint the confidence gaps that undermine it across a range of health conditions and healthcare settings.

Consider a Quick Check-in

A quick check-in with patients might work wonders: “OK, just to hear it in your own words and make sure we’re together on this, how would you explain what’s happening with your health to a friend, family member or even another doctor?” If that’s proving hard to answer either factually or emotionally, additional conversation, questions, appointments and follow-up are worth the investment.


Expectations Color Satisfaction

While healthcare systems are trying to support patients, patients aren’t necessarily embracing their support. One example: just 12% of our subscriber population took advantage of a system provided health advocate, social worker or case manager to coordinate hospital care. We do know from our research that patients who have realistic expectations – for the length of recovery, about possible side effects, and of course for the actual clinical outcome — are generally more satisfied with their treatment. Thus, providers and systems should prioritize ongoing communication with patients and families about what they can definitely, likely and possibly expect to happen next and throughout their treatment. Of course, that is exactly what Consumer Reports coverage of health services and treatment tried to achieve, so that is a somewhat biased recommendation!


What Patients Want to Know

It’s vital to know about infection rates, helpfulness of staff and absence of complications, and I can research those on the internet. But what I really want to know is which health systems and providers will work with me to strengthen my ability to meet future health challenges with confidence and grace. That’s the patient role model I strive to follow for myself and for my family.


Elissa Schuler Adair, PhD Elissa Schuler Adair, PhD, is a consumer health advocate committed to providing patients with the information and support they need to make the health decisions that are best for them and their families. Elissa served as Manager of Health and Survey Research at Consumer Reports Magazine from 2008-2013. She is now Director of Communications and Outreach for Donate Life Northwest.

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