Medical innovations surround us: needle-free vaccines, personalized medicine, bionic eyes. When most people think of innovation, technological or pharmaceutical advances come to mind. But what if there were one simple aspect of medical treatment that everyone had access to, costs very little, and could profoundly change the health of every patient with a chronic health condition? Would you consider that an innovation?
The answer is simple – communication between patients and providers. Words. Tone. Advice. Instructions. Questions. Communication is more of a fundamental than an innovation. But without communication, patients would not able to receive the care that is best for them. And providers would not know the important context in which to interpret clinical values and symptoms. In fact, without communication, doctors would not know about some symptoms at all—symptoms with no objective value or name—things like “I have trouble walking to my mailbox because I am so short of breath” or “My pain gets worse when I walk upstairs.”
Trust me, I am a fan of innovation. I just wonder if the fundamentals of health care are minimized because they lack the cool factor. And focusing on the fundamentals, like effective communication, can have a tremendous impact on both quality of care and healthcare costs.
Common chronic diseases in our population today, such as type 2 diabetes, chronic obstructive pulmonary disease (COPD), congestive heart failure, and asthma, all depend on patients self-managing and making everyday decisions, including interpreting and following medical advice, taking medication, following a diet, and deciding what information to share with their doctor. Patients largely manage their conditions on their own every day; providers get only a glimpse of what is going on. That’s why communications is so important.
What can be discussed in the average 7-minute patient-provider conversation to set patients down the right path? How should that 7 minutes be spent? What questions should the provider ask? What information should the patient share?
With many chronic diseases, prescription treatment is necessary. Indeed, patients must leave the office visit with the right medication for their needs. But I would argue that communication, not medicine, should be elevated to first-line therapy.
Providers have an opportunity to uncover what matters most to patients—and to uncover what patients are most willing to do. Discussing the clinical benefits of starting a new treatment does little to help patients who don’t see their condition as chronic. Perhaps that 7 minutes would be better spent on improving the patient’s health in another way, such as discussing goals related to diet or addressing challenges the patient is having with their medicine.
Healthcare organizations today focus mostly on clinical and technological innovations to improve both the continuity and the quality of care. Fundamentals, like communication skills, are getting lost in the mix. It’s time we think about equipping providers with the knowledge from recent advances in behavioral science by investing in skill-building programs and resources to help providers apply communication strategies such as motivational interviewing and shared decision making. These evidence-based approaches can drive the lasting changes in behavior and outcomes that are needed to meet today’s success metrics.(Read full post)
Patient engagement is a concept that we’ve been hearing a lot about for the last couple of years and one that is critical to impacting health outcomes. As we’ve seen in our own research, oftentimes industry terms are considered buzzwords and carry different meanings to different people. While there isn’t true consensus on the exact definition, even greater uncertainty for me remains around the steps required to actually create an engaged patient.
Type “patient engagement” in Google, and you get 754,000 results. There are sites that claim they’ll help you boost patient engagement, help you create motivated and engaged patients, and even provide tools to help healthcare providers better understand why patient engagement is so important. Clearly, it’s an important topic, but who do you listen to when it comes to motivating patients? What is truly important?
I watch a lot of TED Talks, and one that sticks out in my mind was presented by e-Patient Dave. Dave was diagnosed with terminal cancer, but through networking and social media, was able to find a treatment that ultimately saved his life. He has a website that contains his own postings, guest entries, and other resources from the patient and HCP perspective.
In March, Dave shared a guest post, written by Dr. Patricia Flatley Brennan, that talked about the importance of technology in creating an engaged patient. I agree, technology allows for so many different experiences for patients and providers that were not available just a handful of years ago. But when I read the title, Patients+Providers+Technology=Engagement, the first thing I thought was, “It’s not this simple.” Questions and thoughts were popping into my head, like:
- What if patients have inaccurate perceptions about their condition?
- What if the provider uses terms that the patient doesn’t understand?
- What if the technology is just information overload?
- Technology alone isn’t the answer
Dr. Brennan makes some really good points. For example, she talks about the fact that patients are truly the experts when it comes to their own bodies. She also talks about the importance of patient-provider communication. But she goes on to state “the key to…creating successful partnerships between patients and providers is technology.” As a behavioral science expert, this made me nervous. We don’t want to be sending the message that if technology is included, patients will be more engaged. As I stated earlier, it’s just not this simple.
Take physical activity trackers, for example. Lots of people use them to track their daily activity. They may even bring their trackers to doctor’s appointments. But these trackers are nothing more than a digital way to track activity. For patients who are also struggling with things like not knowing how to exercise, not knowing what exercises to do, not knowing what equipment they need, or believing they need to lose 50 pounds for it to matter, a tracker, while digital, isn’t going to help them with these underlying issues. As a result, they are no more engaged before or after using the tracker.
I don’t dispute the value of any of the programs that are presented in the posting. In fact, many of them look really great, and deserve attention for the positive change they’ve helped create. What I am cautioning against more generally is promoting technology alone as the key ingredient. While technology is important, paying attention to the underlying drivers of behavior is equally critical in promoting change. Starting with an understanding of what drives behavior, then integrating this with technology, can yield powerful tools that will not only change patient behavior but also impact health care delivery and clinical outcomes.
I’m not in any way downplaying the role of technology here, but suggesting that taking into account the drivers of behavior can lead to even more meaningful technological developments.(Read full post)
The Affordable Care Act has plunged electronic health records (EHR) into the process of care. And ultimately there are many advantages that I think we will see – greater continuity of care, and the ability to measure and track meaningful population level health outcomes. Along the way, health systems and ACOs have to demonstrate “meaningful use” of EHR – meaning that health professionals must demonstrate that EHR is being used to have a positive impact on patient outcomes. This push for meaningful use has led to a number of applications including patient health portals. In the context of patient health portals, providers are demonstrating meaningful use of electronic health records by allowing patients to have access to their medical records and health information online. Sounds great, doesn’t it? Give patients more information, because more information is what they need. Right? Not necessarily. In fact, a recent research letter published in JAMA demonstrates that meaningful use of EHR yields marginal and in some cases, worse, quality care measures.
On the surface, patient portals have benefits. It’s convenient. You can review test results online. Some health portals even allow you to exchange messages with providers – but not many are welcoming this functionality yet.
For two reasons, I would argue that this attempt to cast patient portals as a meaningful use of EHR is a little misguided, maybe even meaningless – if you think about it in the context of advancing patient outcomes.
First, without context from the provider, test results and other medical information is open for interpretation. Let me speak from firsthand experience. I recently reviewed some lab results for my mother via her provider’s health portal. It was easy to access. There were a ton of test results and the ranges for normal and abnormal were listed alongside her results. Even as a nurse, I honestly had trouble interpreting what the results meant. Given the context of her symptoms, of previous lab results – without guidance from her provider, I found myself feeling unnecessarily alarmed by what I was reading. Even with additional research online to help me interpret the results, I still felt confused. So, we waited for her appointment 3 weeks later and the provider guided us through the results, helping us understand why he had ordered those specific lab tests, what they meant, and what the next steps were. Information without context cannot be absorbed in meaningful way.
Secondly, while information is great, information in itself does not engage patients in care. Decades of behavioral science research demonstrates that knowledge does not equal behavior change. Patients need motivation and also just as important, the skills to effectively engage in their care. Some suggest that patients having access to their medical records is the “single most powerful moment in the movement towards the empowered patient.” I disagree. While I think access to medical information and medical records is certainly a small step towards engaging patients, there’s much more on the table to think about. Patients can’t become actively engaged in their care unless “we meet patients where they are” and equip them with the skills to self-manage their condition.
No doubt, technology can play a powerful role in patient health in many ways. However, in terms of patient portals, I look forward to next generation applications of EHR that not only fully harness the technology and data, but also leverage a fundamental understanding of patient behavior and what it takes to equip patients to engage in their care.(Read full post)
Since the 2nd century AD, humans have been fascinated by one thing: ourselves.
Roman Emperor Marcus Aurelius’s To Myself (Τὰ εἰς ἑαυτόν), written around 180 AD, is one of the first existing diaries ever written. Today, most of us have smartphones for life-logging and many even have technology that keeps track of our lives for us. (I have been wearing a FitBit for the past few weeks. This device records the number of steps I take, calories I burn throughout the day, and other data.)
The digital age has made the process of recording everything we do even easier, and the Quantified Self movement, as it has come to be known, is gaining in popularity. We may bemoan our friends instagramming their every bite and tweeting their every trip to the gas station. However, there are some useful applications of these activities for the management of chronic diseases.
In conditions like diabetes it is known as self-monitoring: paying attention to changes in symptoms and other data like blood glucose levels or the effects of medications. Patients and their providers can use information gathered through self-monitoring to make treatment decisions and reinforce positive behaviors. For example, if a patient with diabetes feels more energetic and sees their blood glucose levels drop when they stick to a healthy diet, they may be more likely to make that lifestyle change a habit.
So whatever your opinion on life logging, it isn’t going away anytime soon. Let’s just hope we use our obsession with ourselves for good.(Read full post)
I don’t go to the grocery store that often. At work, we have a group called Expedite Group who will do our shopping for us. This not only saves me time, but probably money, too, because I’m not able to just pick up extras that look “interesting” or “tasty.” I also don’t have to worry about falling victim to purchasing extra snacks and junk food as a result of hunger. I have friends who tell me this happens to them all the time, and apparently they’re not alone. An ABC News report investigated this exact topic and found that hungry shoppers not only purchase higher calorie and less diet-friendly foods, but as a result they eat worse all week. So one day of hungry shopping dooms you for seven days.
OK. So if you must physically go to the store, the solution is to just make sure to have a good snack or meal before shopping. If you do this, then you’re good. You won’t mess up your new diet or overspend. Sadly, no.
According to a new study in the journal Obesity, even if you go to the grocery store on a full stomach, shopping after a night of poor sleep can also have deleterious effects on your food choices. Not only are people hungrier when they get less sleep, but it’s long been known that decision-making, in all aspects of life, is affected by sleep deprivation.
In this fast-paced society we live in, five to six hours of sleep is sadly normally for many. So many of us are walking around sleep-deprived. Groups like Expedite Group are wonderful solutions for companies looking to improve work-life balance for employees. They take the burden of grocery shopping, returns, and other errands off the plates of employees to help them focus on work and family life. But this new obesity research shows that helping to improve work-life balance shouldn’t be their only hook for prospective clients. While hiring someone else to do your food shopping is certainly not the only way to stay on track with food choices and health management, it may be a start.(Read full post)
Technology has been connecting us to one another in more ever-present ways, and networking has become virtually a requirement for getting a job. So it is sort of ironic that introverts are now experiencing their time in the sun… before scurrying away to avoid all of that attention.
There have long been misperceptions about what it means to be an introvert, or an extrovert for that matter. Introverts are “quiet” and “shy”. They avoid social contact and don’t like to speak up. Extroverts on the other hand are “loud” and “outgoing”. They like parties and always need to make their opinions known. Personality research tells us, however, that 1) Introversion and extroversion, at their core, reflect where people focus and get their energy, and 2) Most people fall somewhere along an intro-extroversion spectrum. Introversion and extroversion each come with their own strengths, whether it be a tendency to give things careful consideration before speaking, or feeling comfortable voicing opinions on the spot.
To me, the most interesting aspect of personality research is its capacity to help people realize things about themselves. It helps us to uncover our own strengths, tendencies, and motivators, as well as understand others a little bit better.
So toss aside those stereotypes of wallflowers and party animals and really get to know the introverts and extroverts in your life.(Read full post)
Did your parents ever forbid you from hanging out with that kid who was a “bad influence”? What about those friends who eat McDonald’s for every meal? Do people actually do that? And would you think of them as bad influences? You probably should. It turns out that poor health habits are contagious and may have decades-long implications.
We public health geeks call this social norming, or the effects of ones’ peers on their health. Bottom line: The people we surround ourselves with influence our environment, our behavior, and ultimately our health.
For those of us who like to look at the upside of social networks, determinants of health, the combined influence of our interpersonal, community, and ecological environments on our… Maybe this is really just me. In any case, I am happy to hear that people who are healthy tend to encourage their friends to keep healthy habits.
Personally, I am stretched to fit in either social or physical activity time into my busy schedule of nerding out at MMC and trying to keep my life together at home. My similarly strapped friends and I have a solution: A bi-weekly activity-based meet up. By changing up the typical dinner-and-drinks social routine, we hope to encourage and motivate each other to get moving, while still giving us a chance to catch up.
So far our ideas include beach volleyball, tennis, and swimming… Last week we went for a looooooong walk. We may have followed it up with a taco binge, but hey, at least we’re trying!(Read full post)
What do these entities all have in common?
Unless you looked at the tags for this post, you will probably be surprised to hear that they all have departments dedicated to behavioral science. From the U.K.’s national behavioural insights team, to the FBI’s Behavioral Science Unit, to our own Behavioral Services team, there are specific groups dedicated to figuring out what makes people tick. As someone who has always been interested in the quirks of human behavior, I am fascinated to see the variety of problems that are being solved with behavioral science research:
- Reducing energy consumption on a national scale
- Helping patients with chronic conditions to have a better healthcare experience
- Convincing people to pay their taxes
- Helping law enforcement agencies to better understand criminals
This is all to say, our task of using behavioral science to take over the world is almost complete. Mwahahahaha!(Read full post)
What do parents, teachers, doctors, and public health professionals have in common?
We all want kids to eat healthy foods.
Those of us interested in school nutrition have been fighting for decades to get healthy lunches available in schools. Unfortunately, things things don’t always go our way. (In what universe is pizza a vegetable?) Then there is the challenge from school boards who are convinced that vending machines are the key to their financial viability. Some schools have actually been able to remove unhealthy options from the cafeteria… resulting in kids bringing chips from home in record numbers. It sometimes seems like we just can’t win here, and the reason is simple: We, kids and adults alike, do not like to be told what to do.
Enter classic behavior modification techniques and the power of choice. You may be surprised to learn that there are a few simple and interesting strategies to encourage healthy eating. Read on to learn how to prevent kids from rebelling against healthy lunches, and to build their skills choose healthy options in the future.
- Apples on impulse
Rather than keeping candy bars, chips, and other less desirable snacks near school cafeteria cash registers, put fruits and vegetables there. That way, impulse buyers will be choosing from a healthier set of options.
- Shifting the salad bar
In many school cafeterias, salad bars are pushed off to the side so students have to go out of their way to select this option. One school moved the salad bar to the middle of the cafeteria so that kids had to walk around it to get to the cash registers. They subsequently saw a 21% increase in salad sales.
- Carrots or cauliflower?
When students are given a choice of which vegetable they eat, food waste decreases and vegetable consumption increases. What more could a fiscally and nutritionally conscious school board want?
So there you have it. Getting kids to eat broccoli is easy. You just have to convince them that it was their idea.(Read full post)
Dismayed television viewers collectively sucked in their breath — and their stomachs — when former White House doctor Connie Mariano chose an all-too-public forum for her fears that New Jersey Governor Chris Christie might “die in office” because of his weight. I couldn’t help thinking how different that unfortunate moment might have been if Dr. Mariano had used behaviorally sound strategies to deliver her message more effectively.
Late-night jokes and running pun-laden headlines aside, Dr. Mariano no doubt has Gov. Christie’s best interests at heart. Although it is doubtful she routinely uses that sort of alarmist language in the exam room with her patients, the episode demonstrates why well-meaning and even urgent healthcare advice goes unheeded by patients. Gov. Christie’s strident rebuke of Dr. Mariano also dramatically illustrates the emerging power of the patient and the changing doctor-patient dynamic in this age of healthcare reform.
During a press conference, after saying Dr. Mariano should “shut up,” Gov. Christie said he has a plan for dealing with his weight, adding, “My doctor continues to warn me that my luck is going to run out relatively soon, so believe me, it’s something I’m very conscious of.”
A behavioral science–based approach might have helped Dr. Mariano view Gov. Christie’s awareness of his blood pressure and blood sugar levels (normal, according to him when he appeared on Letterman) as positive indicators for change. His “luck” terminology could indicate a belief he has little control over the situation. Rather than jumping to negative conclusions, if Dr. Mariano was armed with the proper insight, she could have employed positive framing, and used an approach that tapped into Gov. Christie’s heath behavior drivers that might motivate him to take action.
Instead, the dramatic public backlash, which played out on the political stage shows how there continues to be a gap in communicating and managing chronic conditions. Dr. Mariano’s cringe-worthy comments, along with Gov. Christie’s outrage and subsequent good humor and surge in the polls to a 74% approval rating need little analysis. What they do require, however, is recognition that it takes more than good advice to move patients toward positive lifestyle change. In today’s complex (not to mention politically charged) healthcare environment, it’s not enough for doctors to diagnose the problem and provide information. Patients demand a greater say in their own care, and everyone involved is being held accountable for better patient outcomes. Fortunately, doctors can use effective patient-centric approaches to help patients overcome barriers to improving those outcomes.(Read full post)