This topic has been growing and has
been presented in many other places besides the five references I
will present. The topic is “patient engagement.” The term has
been around since sometime in the 1990s, or maybe earlier, but really
came into full use in 2012. My first exposure to the term was in Dr.
Rob Lambert's blog here. In turn, I blogged about it here.
The definition is very loose and
depends on who is defining it. Dr. Leslie Kernisan does a decent job
of defining the phrase, but other people want to define the term as
well. When the defining will arrive at one meaning remains to be
seen. Back to Dr. Kernisan's definition, which says, “Supporting
patient engagement means fostering a fruitful collaboration in which
patients and clinicians work together to help the patient progress
towards mutually agreed-upon health goals.”
“In other
words, to truly foster patient engagement, it's not enough to just
work together more closely on achieving a given health outcome. It
is also important to work together on deciding which outcomes to
pursue, why to pursue them and how to pursue them. In doing so, we
engage patients in a meaningful care partnership that respects their
priorities, preferences, perspective and situation. Communication
with patients is, of course, essential to all of this. This is why
any innovation that improves a patient's ability to access and
communicate with health care providers is proudly labeled as "patient
engagement."
To me, all this is fine, but I still prefer what Dr. Lamberts says.
“Communication isn't important to
health care, communication is health care.
Care is not a static thing, it is the transaction of ideas. The
patient tells me what is going on, I listen, I share my thoughts with
the patient (and other providers), and the patient uses the result of
this transaction for their own benefit.” Bold is my
emphasis in both paragraphs.
“But our
fine system doesn't embrace this definition. We indict ourselves
when we talk about "patient engagement" as if it's a goal,
as it reveals the current
state of disengagement.
Patients are not the center of care. Patients are a source of data
so doctors can get "meaningful use" checks. Patients are
the proof that our organizations are accountable. Patients live in
our "patient-centered" medical homes.”
The Center for Advancing Health (CFAH)
says, “Here is the CFAH definition of
patient engagement (PE): "Actions people take to support their
health and benefit from their health care."
The last definition is not that of most
physicians and if you read the link above, they list six overarching
themes which do not fit with the definition. Then if you read this blog by Jessie Gruman, president and founder of the Center for
Advancing Health, you can understand a little more for the reason
they are pushing this philosophy.
I admit that I have a very strong bias
for what Dr. Lamberts has to say about patient engagement as is does
not foster good communication between doctors and patients and is
contrived to satisfy the “meaningful use” for receiving money for
implementing medical health records. This in turn makes money for
the doctors and makes billing for medical insurance reimbursement
easier.
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