Doctors are regularly deluged with advice on how to engage patients. But how can you, as a patient, get your doctor to truly engage with you as a person? Your health and even your life could depend upon it.
By “engage,” I don’t mean just the doctor not interrupting after 11 seconds. That’s the average time a patient talks before the doctor interjects, said a study published in July 2018. This is down sharply from the “leisurely” 18-23 seconds patients on average spoke uninterrupted in studies from 1984 and 1999.
This rapid interaction may be fine when you’re trying to figure out if you have a broken ankle. However, that perceived absence of empathy can significantly harm your physical and mental wellbeing if your problems are more complex. At a recent Society for Participatory Medicine (SPM) conference (I’m a member), three strategies stood out for patients to short-circuit being given short shrift.
How to respond when your doctor interrupts
1) Individual flair can ignite conversation
Kate Sheridan was 11 years old when she was diagnosed with Lyme disease. Over the next three years, she was referred to more than 30 doctors and was hospitalized five times. The complications from her condition, Kate wrote in a blog post for the Mayo Clinic, changed her from a straight-A student to someone unable to read or write. She went from being a competitive athlete to being bedridden and from an extrovert to feeling isolated.
That feeling of isolation was reinforced by periodic, panicked visits to the emergency room. “The first few visits all saw the same pattern – I was a diagnosis, passed from hand-to-hand until discharge,” she wrote.
Then, when Kate was in 11th grade, a chance comment by an emergency medical tech about her colorful sneakers sparked an idea. She deliberately ordered oversized, multi-colored shoes. These “gave me a talking point with my providers and a reputation in the Emergency Room,” she wrote. “With every new diagnosis and treatment, the sneakers became louder.”
Shoelaces were soon replaced by scraps of cloth, and Kate splashed the shoes themselves with neon paint. Gradually, she emerged “as the goofy kid with the weird sneakers,” not just a “patient” – and her care changed. For example, nurses took more time to be gentle while inserting an IV. And, of critical importance for someone with a complicated medical history and multiple medications, “doctors were willing to hear my whole story and not just a summary. When I had my shoes, I had my voice.”
Kate, often too sick in high school to attend classes, is now pursuing a master’s degree at the University of Oxford.
2) Appeal to the physician as both scientist and healer
To paraphrase the famous Michael Jordan commercial, what turned the tide wasn’t just “the shoes.” Kate and her parents also painstakingly assembled a spreadsheet for her doctors that tracked her symptoms, both mental and physical, and the effects, good and bad, of the treatments.
“Data has power,” Kristina Sheridan, Kate’s mom, told the meeting. (Kate was in England.) “We produced this chart from her voice.”
The strategy of explicitly appealing to the physician as both scientist and healer – to logic and emotion alike – is what saved Doug Lindsay’s life.
Lindsay was someone who loved to dance, play banjo and tell stories until, at age 21, he suddenly found himself barely able to sit or walk. His symptoms resembled a severe case of chronic fatigue syndrome. Confined to a wheelchair, he dropped out of college and quickly began to feel invisible.
As an article about his predicament put it, “Sick, the guy who never had trouble finding an audience couldn’t get doctors to listen to him.”
“Sick and terrified,” Lindsay began reading medical textbooks. Searching for a condition that was rare, he came upon a disease of the autonomic nervous system. Fourteen years after his life was shattered, now healthy, a strong-voiced advocate striding back and forth in front of an audience, Lindsay recounted where he began and what changed.
“I wrote to doctors,” Lindsay said. “They responded, ‘Problems like what you say you have don’t exist.’ But I said, ‘They could.’”
So began an arduous journey to enlist physicians and researchers as collaborators in, first and foremost, finding a diagnosis. In this case, that turned out to be adrenal gland hyperactivity known to affect just 32 patients worldwide. The next step was discovering (or, as it turned out, Lindsay actually helping his doctors invent) a possible treatment. Finally, and perhaps the hardest job of all was enlisting a physician to perform a largely untested surgery.
Each of these tasks consumed years of effort. Although Lindsay’s painstaking research and persistence won respect, persuading doctor after doctor to accept the difficult challenge his illness posed remained a constant struggle. Lindsay says he eventually realized that if he wanted empathy and support, he had to provide both in return.
“I had to show them I cared about the position I was putting them in,” Lindsay related. “I had to tell them that if they failed me, it would still not harm their self-concept as healer. [I had to tell them], ‘You can help me. It’s within your power.’”
3) Let technology pave the path
Clinicians know, of course, that they sometimes have an empathy deficit. In 2013, a Cleveland Clinic empathy video that quietly showed what we don’t see on the inside of the strangers who surround us in the hospital and clinic became a surprise viral hit, sparking tens of thousands of views and bringing tears to the eyes of many who viewed it. Two years later, MedStar Health’s “Please See Me” video emotionally captured the need for open and honest doctor-patient communication.
Still, overstressed providers too often experience compassion fatigue that interferes with their ability to empathetically listen to patients. One possible aid that was voted “most patient-centered” at a health tech meeting held in concert with the SPM conference, comes from a company called PatientWisdom.
Founded by Gregory Makoul, a researcher in doctor-patient communication (full disclosure: also a former colleague of mine Northwestern University), PatientWisdom’s mobile platform lets patients tell their stories. It then shares them in summary form with the entire care team via the electronic health record. Headings include, “This makes me happy,” “Health priorities/goals,” “My agenda,” “Biggest barriers to staying healthy” and “What I wish my doctor asked me.”
Said Makoul, “PatientWisdom has found the sweet spot between digital and personal.”
Separately, a group of patients working with the Society to Improve Diagnosis in Medicine is developing an online toolkit designed to communicate to doctors based on the logic they’ve learned in medical training – your story, but on their terms.
A leader in that effort, kidney cancer survivor Peggy Zuckerman, is a realist. The toolkit, she says, “helps the patient tell his story…in a way that MIGHT get the doctor to hear your complete story.”
The Importance of Self-Care in Chronic Illness Management
4 Ways You Can Improve Patient Engagement
**LOVE OUR CONTENT? WANT MORE INFORMATION ON DOCTOR-PATIENT COMMUNICATION? SIGN UP FOR OUR WEEKLY NEWSLETTER HERE**
Michael L. Millenson, President of Health Quality Advisors LLC, is a nationally recognized expert on making American healthcare better, safer, and more patient-centered. He is also an adjunct associate professor of medicine at Northwestern University’s Feinberg School of Medicine.
He has testified before Congress and written for publications ranging from the British Medical Journal and Health Affairs to The Washington Post and Forbes.com. Michael has consulted with policymakers and with a broad range of clients from all segments of the healthcare industry, providing services ranging from strategic planning to develop specific tools to improve care. He has served on the advisory board of several healthcare start-ups and currently serves in an advisory capacity to the American Journal of Medical Quality and the Lundberg Institute.
Earlier in his career, he was a healthcare reporter for the Chicago Tribune, where he was nominated three times for a Pulitzer Prize. A respected presence in health policy and strategy, Michael has lectured at the National Institutes of Health and the Harvard Business School and served as a faculty member for the Institute for Healthcare Improvement.
Michael is the author of the critically acclaimed book, Demanding Medical Excellence: Doctors and Accountability in the Information Age.
All good points. Another tool that has produced very positive results is the use of ‘psychographics’ (the understanding of what motivates people to act) to customize communications with individual patients. This aspect of behavioral science has been borrow from consumer product companies and now successfully adapted to health care. The use of individual customized communications guided by ‘psychographics’ is being successfully used in many areas of healthcare (e.g. reducing re-admission, improving outcomes for chronic care patients, better patient adherence to care plans. even boosting payments from patients and more). By itself, communications base on psychographics may be limited to one-on-one communications. But recently, new technologies have been used to send out ‘psychographically customized’ communications ‘at scale’ to large populations with great success (individual customized messages to large populations. Results such as over 50% reduction in CHF re-admissions has been achieved by just changing messaging from ‘one size fits all’ to ‘customized messages to individuals enhanced with psychographics’ and other similar positive results across other areas of healthcare.
Comment will held for moderation