July 18, 2014

An Elusive Definition and a Discussion

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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