Young doctor smiling at patient
Photo credit: Mercy Health | CC

Not long ago, Lloyd Dean, president and CEO of the San Francisco-based healthcare system, Dignity Health, announced the Dignity Health and Box Patient Education App Challenge. In the course of the announcement, Dean is quoted as saying:

“We recognize the immense potential that (health information) technology has to enhance our patients’ care and overall experience.”

Dean’s use of the term “immense potential” with respect to patient-facing technologies like health apps and patient portals got me thinking, “Immense potential compared to what? Your patients and members are in your doctor’s offices not on your patient portals or using a health app!”

With all the hype in the health press about the patient engagement potential of patient-facing health information technologies, one could be forgiven for thinking that HIT is the best, if not only, path to patient engagement.

But, in fact, there is another way—another more immediate, less costly, and proven way.  And its potential to engage patients, enhance care, and improve patient experiences dwarfs the “immense potential” of patient-facing HIT by comparison.


Rediscovering the power of physician-patient exam room conversations

Here’s what I mean. The average office-based physician engages in some 4,224 face-to-face visit-related conversations with patients each year. Depending upon their communication skills, each of these conversations represents an opportunity for physicians to engage patients, enhance care, and improve patient experiences.

In the case of Dignity Health’s 11,000 physicians, assuming they see an average of 20 patients per day per physician, this comes out to:

220,000 patient visit per day 880,000 patient visits per week 45.7 million patient visits per year

Now factor in the 3-4 complaints each patient brings to the visit along with a myriad of beliefs, fears, and expectations for service (tests, referrals, new medications, and so on).   I hope you are starting to realize that each patient visit is pregnant with opportunities for clinicians—your clinicians—to engage, empower and excite patients…sometimes by doing nothing more than listening to what the patient wants to say. Remember these are real opportunities that exist in the here and now. Not some promise or dream of possibilities to come.


3-4 complaints  +  2-3 requests  +  4-5 expectations  =  Lots of opportunities to engage patients

At this point you might be thinking that your physicians are already leveraging these exam room opportunities to build your organization’s brand, to refer patients to your specialists and ancillary services, and to direct patients to health information on their/your patient portal. You would probably be wrong. Not because of the limited time available during the office visit, but rather because many physicians have never been trained or provided with the communications tools needed to recognize or facilitate these kinds of opportunities. But that is the topic for a separate post.



The patient-facing HIT opportunity

Now consider the opportunities in Lloyd Dean’s brave new world—a vision shared by HIT professionals health developers, vendors, and their respective professional organizations.

Staying with the Dignity Health example, let’s assume that each of Dignity Health’s 11,000 doctors have patient panels of 2,300 adults and that 10% of these people use their respective patient portals or smart health apps 5 times per year (a generous assumption).  This comes out to approximately 12.6 million opportunities for Dignity to engage, empower, and excite patients/consumers per year.

It’s doubtful that the opportunities for meaningful engagement afforded by a patient portal or health app compare qualitatively to the opportunities possible with a face-to-face physician visit. Being able to check one’s lab tests, schedule an appointment, or refill a prescription while convenient do not afford the same therapeutic benefits of a listening ear or the touch of a clinician’s hand.


The takeaway

The real “immense opportunity” for engaging patients, enhancing patient care, and improving patient experiences lies behind the closed exam room doors of physicians’ offices. That is the most frequent point of contact healthcare consumers have with the healthcare system. It is also where truly meaningful patient engagement and memorable patient experience take place.

Engaging patients, enhancing care, and improving patient experiences is not an either-or choice between more health IT or better physician-patient communications. Providers will need both in the long run. HIT will enable clinicians with good patient communication skills to touch more patients and get more done. Physicians, in turn, will recommend that patients go to their patient portals and smart apps for health information.

Imagine the ROI that organizations like Dignity Health’s could realize from their investments in patient portals and health apps if all 45.7 million annual patient visits were given a tailored information therapy prescription directing them to one or the other or both.

Now that is what I call IMMENSE POTENTIAL!

That’s what I think….what’s your opinion?

First posted at Mind the Gap on 11/21/2013.

Stephen Wilkins
Principal and Founder, Mind The Gap Academy, a thought leader, research, and solution provider company specializing in physician-patient communications, patient engagement, and patient-centered/relationship-centered care. Steve has over 25+ years of professional health care experience working in and consulting with hospitals, health plans, physician groups and solution vendors. The balance of his experience has been in working with provider organizations in the areas of applied consumer health behavior.


  1. This is something that I’ve been wondering about. My ENT says that I’m one of the very few patients that uses the EHR. I actually sent him a question, and he was so excited that somebody used it, that he had his nurse fit me in the next day. I had a tonsil stub that a radiologist thought was a cancer. It wasn’t, not even precancerous-PRICELESS-. I’m wondering if they have an ap for that?

    My PCP decided that my strep throat wasn’t strep, but a side-effect from radiation. I even took a note from my oncology radiologist for the reasons my symptoms were not related to cancer or radiation.

    I was telling this to my new PCP-and he immediately started telling me how to keep my mouth and throat lubricated. I interrupted him. I said, “Watch this.” I held out my hand and spit in it. Then I said, “This is why my oncology radiologist says my throat problems are not cancer or radiation related”. He ran a strep test-it was positive again.

    My strep is gone. I paid for my family to go to a clinic and get strep tests to make sure that there wasn’t a cross transference. They were negative. I bought new toothbrushes, etc. I don’t need an app to tell me to drink out of a clean glass.

    I felt like my head was in an oven from May to October. In July, I finally found an elderly Urgent Care doctor that ran a strep test. It was hot. I took the antibiotics. I got a little relief that quickly faded. In my follow-up with my PCP, I begged for another strep test, lab work. He told me that I had to learn to live with chronic problems caused by cancer and treatment.
    This is part of what your’e saying, nothing like some positive interaction in the exam room.

    I wish there was an app for doctors, where lights would flash, the doctor would be shocked, and a booming voice would say-PRACTICE MED 101-

    Are these apps going to be like a 24/7 nurse line, where you say, “I stubbed my toe”. They say, “Go to the ER.” Personally, I think the nurses are in various stages of Alzheimers.

    There was an article about apps, I made a negative comment about apps on smart phones. The author got all over me, and he told me that if I gave reasons why I don’t want apps on my smartphone, he’d help me.
    I told him that I don’t have a smartphone, my fingers R 2 stiff 2 text, I have 2 PCs (one is for Adobe photoshop), a laptop, and a tablet, so I can game, while waiting for a doctor’s appointment and keep a calendar. He never got back 2 me 2 help me.

    There’s a lot wrong with American medicine, and it begins with doctors that need to get the wax out of their ears. I used to teach math to HS juniors until a few years ago. I know that I can enunciate loudly and clearly.


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