Patient-Centered Care

When it Comes to Engaging Patients, Health Care Providers are Lost in Space

The challenge for healthcare providers today is not how to engage their patients…but rather how to be more engaging. This is an important distinction. Grasping the distinction can make the difference between a highly effective, satisfying patient experience and what many of us get now – average care and experiences that leave us wanting for something better. Here are some facts to consider. Every year some 82% of adults in the U.S. visit their personal physician. The national average is 3 visits/person…double that for people with chronic conditions. This includes you and I.

Engaged or Not?

Now think about the decisions we make before we make an appointment to see the doctor. First, we consider whether a trip to the doctor is necessary. Some of us may go online to Elderly woman at home typing something using her laptopresearch our symptoms, some of us may consult with our family and friends, and so on. Then we make a decision to make the appointment (or not). We then pick up the phone or go online to schedule an appointment. We then have to take time off work and get ourselves to the doctor’s office. While at the doctor’s office, we have to endure the office receptionist and take a seat. While in the waiting area and exam room, we ponder the questions we want to ask our doctor…maybe we brought a list. Most of us put a fair amount of “thought, effort and time” into seeing the doctor. Right? Now answer this question. Would you put this amount of thought, effort and time into something you are not interested in or feel is not important…something you weren’t engaged in? Of course, you wouldn’t and neither would I. So how is it that so many of us are guilty of “group think” that says that most patients are unengaged when that clearly is not the case? But wait you say…if people were engaged wouldn’t they do what their doctor tells them? Wouldn’t they be more compliant? Wouldn’t they exercise more and be healthier? Wouldn’t they be more willing to sign up for and routinely use our patient portal and PHR? In a word…NO. Why?

A Look Inside the Exam Room

The exam room is where the doctor does most of the talking. Patients are expected to assume a passive sick role and respond only to the doctor’s questions. Physicians and patient frequently disagree (which generally goes unstated by either party) and fail to understand critical elements of the visit including the reason for the visit, most important health issues, requests/expectations for service, diagnosis, severity of their condition, treatments and so on. These disagreements and misunderstandings often preclude patients following through with the doctor’s recommendations. In spite of all the talk about patient-centeredness, the exam room is still a physician-dominated experience for most of us. While lack of time may seem like a good explanation for these rather unengaging patient experiences, you would be wrong. The reason most physicians will give you is that they don’t have the right set of patient-centered communication skills or knowledge. Most physicians, after all, still employ the same paternalistic, physician-directed patient communication skills they learn in medical school.

What Can Physicians Do to be More Engaging?

The answer is not to go out and spend gobs of money on fancy patient portals, PHRs and health apps in an attempt to compensate for their physicians’ lack of patient-centered communication skills. Nor is the answer to delegate responsibility for effective patient communications to a team of ancillary staff. Doctor and Patient Team What providers need to do is walk the talk by investing in developing their patient-centered communication skills. The rewards for doing so will not only enable providers to be more engaging, it will also lead to more productive office visits, better patient outcomes, lower use and cost, and exceptional patient experiences.


Stephen Wilkins, MPH Steve Wilkins, MPH, is the author of Mind the Gap, an evidence-based blog aimed at improving how physicians communicate with and engage their patients beginning in the exam room. He is also the founder of the Adopt One! Challenge which challenge physicians to commit to developing one new patient-centered communication skill in 2014. Steve has over 25 years in working with health plans, hospitals and physicians to engage, empower and excite patients and consumers. Website: Twitter: @Healthmessaging LinkedIn:

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