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Patient Engagement Tip of the Month

Geri Lynn Baumblatt, MA, is the Executive Director of Patient Engagement at Emmi Solutions where she oversees the creation of multimedia patient engagement, education, shared decision-making, and behavior change Emmi programs and interactive phone calls. She hosts an annual October Health Literacy Month blog series for Engaging the Patient. She regularly speaks and serves on health literacy and shared decision making panels for organizations like AHRQ, the Institute for Healthcare Advancement, Health Literacy Missouri, and the Center for Plain Language. She also serves as an Editorial Board member for the Journal of Patient Experience. Emmi Solutions works with decision scientists, behavior change experts, patients, and clinicians; they draw on their research and experience to create content that helps patients engage in their care.


Posted: Wednesday, April 29, 2015

Meeting the Patient’s Communication Needs

By Geri Lynn Baumblatt, MA, Executive Director of Patient Engagement, Emmi Solutions
Co-author: Randi Redmond Oster, author of Questioning Protocol

When Randi Oster’s 15 year-old son Gary was first admitted to the hospital for Crohn’s disease, he was in massive pain. Unfortunately, his regular GI doctor is away at a conference.  The family waited for hours until a physician arrived and did a quick exam and said, “He’s an excellent candidate for surgery.”

The family was stunned. Surgery? No one had ever mentioned this before. To them, this came out of left field. And based on Randi’s past experience with her father, she felt any surgery was fraught with risk and was something to be avoided whenever possible.

Randi had nothing but questions. And their family was not comfortable deferring to the first recommendation. She realized launching into a barrage of questions might put the doctor on the defense.

She decided she first needed to help the new doctor understand their family. She explained that her son is analytical and literal; and that he likes and needs a lot of details and facts.

Randi also explained that while the protocol might be surgery, their family’s process was to gather options, ask a lot of questions, understand the risks and benefits so they can share in the decision and be involved and informed every step of the way.

By being clear up front about the level of information they needed, the physician and medical team were able to meet expectations and provide more detailed and in-depth communication to help find the best option for Gary.


Meeting communication needs: one size does not fit all


Most patients and families won’t proactively jump in to explain what they need or want when it comes their communication style and preferences. Ask patients who they are and what to they want. For some, a lot of details are overwhelming, for others these details help them think through the nuances. And ask how involved would they like to be in decisions?

Research shows that when patients share in the decision making process most (74%) have more realistic expectations.[1] That can make for better decisions and a better patient and family experience.


[1] Source: Impact of Decision Aids The Cochrane Library 2014, Issue 1
 



Randi Redmond Oster is the award winning author of Questioning Protocol, which helps patients navigate the healthcare system and medical professionals understand the patient perspective. She is also the co-founder and president of Help Me Health, which transforms how healthcare thinks about and delivers patient experience to achieve better outcomes. @helpme_health

Tags: communication, shared decision making
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Posted: Monday, March 30, 2015

How to Start a Hard Conversation: Engaging Patients in Advance Directives

By Geri Lynn Baumblatt, MA, Executive Director of Patient Engagement, Emmi Solutions
Diana Dilger
Co-author: Diana Dilger, Senior Writer, Emmi Solutions

No one likes to bring up death. People like it even less when it’s about them. But that’s not a good reason to avoid it. It’s an important discussion, and we have a responsibility to promote these conversations so patients can have a say in what they do and don’t want.

How do you bring it up?
First, if someone isn’t seriously ill, bringing up advance directives (AD) can seem jarring and out of the blue. It can help to ease into it by saying things like, “Since everything looks good now, this would be a great time to talk about what you might want if you ever do need something and can’t speak for yourself.” Or normalize it: “It looks like you don’t have AD on file. We try to have those for everyone in case you’re ever in an accident; it’s a great safeguard.”

For people who are ill and know something could happen, it might sound more like, “We have your treatment planned for now, but let’s talk about what you may or may not want if treatment doesn’t go the way we hope.”

Then, explain how ADs are a gift to their family. If someone is in an accident or becomes unable to speak for themselves, and there aren’t ADs, it can create a lot of stress, guilt, disagreement, and confusion for their family. So getting it down in writing and alerting everyone to what they want in advance can be a big relief. It's like leaving a guide book for their loved ones.

Address Common Concerns
People are afraid once they create ADs, they’re locked into them. Letting people know they can change them at any time if their wishes change puts people at ease. It also helps to emphasize that putting an AD in place does not mean they’ll get less care. Instead, saying what they do and don’t want helps ensure they’ll get the care they prefer.

National Healthcare Decisions Day
April 16 is dedicated to encouraging people to discuss and document advance directives.
Check out all the events going on for National Healthcare Decisions Day.

Help Everyone Understand
To help educate the public, the multimedia Advance Directives Emmi program will be freely available to the public for two weeks, starting April 16. View it here.

Learn from Experts
A complimentary webinar on with Dr. Ira Byock and Dr. Sheri Kittelson on
Engaging in End of Life Decisions: How to Turn Difficult Conversations into Clinical Opportunities
11 am Central on April 16. Sign up here.


Diana Dilger is a senior writer at Emmi Solutions. She wrote the multimedia Emmi programs on advance care and end-of-life treatment (Advance Directives, Hospice Treatment Options, and Palliative Care). In addition to encouraging others to talk about end-of-life wishes, she boasts a shiny, new set of advance directives for herself. @dianadoesthis


Tags: communication, personal healthcare, end of life
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Posted: Thursday, February 26, 2015

Engaging Patients in Hourly Rounding: Improving the Patient and the Caregiver Experience

By Geri Lynn Baumblatt, MA, Executive Director of Patient Engagement, Emmi Solutions
Co-author: Greg Berney, Senior Manager of Patient Experience at Cone Health
Several months ago, a Patient Experience Manager at Cone Health was rounding with a nurse on a med/surg department. We’ll call him “James.” As James discussed different patient experience improvement tactics, he verbalized a concern with hourly rounding logs. “Each time I put my initials on that log I feel frustration with leadership because it feels like they don’t trust me.” Leaders, in turn, felt frustrated because the logs were their only way of ensuring hourly rounding was happening.

While James identified a lack of trust as his main frustration, this also articulates a greater challenge in improving the Patient Experience: ensuring our goals and how we motivate caregivers to meet those goals match. As James would tell you, there is nothing about writing his initials on a log sheet that help him provide better care at the bedside. In fact, the log sheet introduces a new goal and motivation for many caregivers - fill it out faithfully and you won’t be hassled by your boss! Hourly Rounding had become a task for James instead of a tool that to provide better care.

How can we tap into caregivers’ natural motivation, and partner with patients, to improve the patient and caregiver experiences at the same time?

At Cone Health, Hourly Rounding was re-launched with a specific focus on helping caregivers understand what’s in it for them. The entire training is around helping each nurse proactively communicate to their patients in a way that ends up reducing call lights.

The best part: patients who hit their call light less frequently tend to do so because they feel their needs are being met!

Engaging Patients In the Process

Instead of using rounding logs to validate their process, Cone has added a question to the Patient Perception of Care survey specifically asking the patient if a nurse came in the room every hour.  Additionally, some patients give this feedback in real time by keeping their own log sheet of which staff members came in the room and when.  

Patient tracking provides added patient engagement benefits that aren’t available through traditional tracking methods:
  • Patients automatically have a better understanding of the processes, which reduces anxiety or fear about being in pain or being forgotten.
  • This allows patients to more naturally partner with caregivers to ensure their needs are met on a mutually convenient schedule.
  • Staff have additional motivation to explain the purpose and process of rounding.  
One could easily view Hourly Rounding as a transactional task - something that we do to patients. Instead, engaging patients creates a more interactional model in which patients are informed and empowered.  In this way, patient engagement leads to improved caregiver experience as well.  



Greg Berney is the Senior Manager of Patient Experience at Cone Health in Greensboro, NC where he addresses organizational Patient Experience and Patient Engagement opportunities from problem identification through innovation, planning, and execution of improvement initiatives. Greg provides project management and consultation for an organization of 6 inpatient hospitals and 100+ emergency, ambulatory and outpatient areas in close collaboration with senior administrative and physician leadership.  Greg’s recent speaking engagements include the Beryl Institute Patient Experience Conference, Dignity Health’s Patient Experience Summit, and the NextGen Patient Experience Summit. Follow Greg on Twitter at @gregberney.

Tags: patient engagement, rounding
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Posted: Friday, January 30, 2015

When Patients Befriend Dr. Google

By Geri Lynn Baumblatt, MA, Executive Director of Patient Engagement, Emmi Solutions
Co-author: Kerry O’Connell, a construction executive from Denver, CO
For mKerry O'Connellany patients, the Internet becomes their best friend. They spend evenings searching for cures for damaged nerves. When Kerry O’Connell fell off a ladder and destroyed his arm, and when surgeries and treatments failed and made his pain and function even worse, he went, as most of us do, to look for answers online.
 
When showing this online research to his physician, he was advised to be careful as much of that info was not reliable. Fair warning, but when people are searching for answers and trying to collaborate in their care, they’re often dismissed and made to feel like they overstepped.
 
Kerry found out he could access medical journals from the med school library. For his next visit he came armed not with flimsy Google search results, but real studies. His doctor was not impressed, saying even studies from last year were out of date and nowhere near the current state of the medical art.
 

People are searching for a reason

It’s often a sign they feel uneasy and don’t have the answers they need. It’s also an opportunity to find out what those are. In Kerry’s case, he was looking for alternatives to more surgery, drug side effects, better descriptions of typical outcomes, and empathy from others who had gone through the same thing.
 
Anytime we can provide patient-friendly resources that proactively answer these questions, it can help keep people from going down those online rabbit holes.
 
But people can also find meaningful information. Sometimes it’s the empathy and support from connecting with others. Other times, people like Dave deBronkart can find out about a medical treatment for his rare cancer by talking to an online patient forum. A treatment his physicians didn’t know about at the time.
 
As patients and families increasingly turn to online resources, how do you help them find the good ones? And how do you work with them?



Kerry O’Connell is a construction executive from Denver, Colorado, who builds infrastructure by day and lobbies the healthcare industry by night. His favorite causes include infection prevention, medical device training and creating a post-harm standard of care. His articles have appeared in places like Health Affairs, and he regularly provides the patient perspective at conferences like the Summer Institute for Informed Patient Choice.

Tags: patient engagement, doctor's appointment, personal healthcare
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Posted: Friday, December 19, 2014

Beyond Sticks and Stones

By Geri Lynn Baumblatt, MA, Executive Director of Patient Engagement, Emmi Solutions
The old adage ends “…but words will never hurt me.” And most of us agree words may hurt feelings but not cause physical pain. However, we also know the emotional and physical are not completely discrete and separate experiences. We’ve all experienced how language or even a friendly text message can affect our mood and emotions. But more evidence points to language having an impact on at least some physical experiences.
 
This year, at the International Conference on Communication in Healthcare, a symposium on communication and pain discussed recent research showing that while words, themselves, may not literally hurt people, language, tone, or just avoiding the word “pain” can have an impact.
 
For example, women recovering from a C-section were either asked: “How are you feeling?” or “Do you have pain?” Did the phrasing of the question change reported pain? It did.
  • When asked “How are you feeling?” only 24% of women reported pain.
  • And when asked, “Do you have pain?” that percentage more than doubled, with 54% reporting pain.
A similar study asking women to rate “pain” vs. “comfort” on a 0-10 point scale also found the women who were explicitly asked about pain had higher pain scores.
 
As psychometricians and political pollsters know, how we ask questions matters. And that’s not always a bad thing. In this case, asking a more open-ended question may improve the experience or perception of pain.

Tags: communication, pain
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Posted: Thursday, November 20, 2014

Helping People Make Changes Beyond the Exam Room

By Geri Lynn Baumblatt, MA, Executive Director of Patient Engagement, Emmi Solutions
Guest blogger: Scott Strange, a 2014 MedicineX ePatient Scholar has been a Type 1 diabetic since 1970. He is especially interested in removing the stigma associated with so many health issues and with mental health in particular. He blogs at Strangely Diabetic and you can find him on Twitter as @strangely_t1.

Many things can affect an individual’s ability or willingness to follow our treatment regimens. Cost, time, life, not believing it’s important, maybe not really understanding, stress, burnout, and depression to name a few.
 
Having been a Type 1 diabetic for 45 years, I sometimes need more than my annual physical may reveal. And patients in any number of chronic communities do as well. Those extra needs often directly address why I am having so much trouble being ‘compliant’, doing what I am supposed to be doing to maintain my health over the long haul, not just until my next appointment. And honestly, I might spend two or three hours a year with doctors -- leaving me up to my own devices for the other 8758.
 
But the truth of the matter is that we are rarely asked ‘why?’ and just told to do better, when what we really need is help changing our behavior. Behavior change is hard work, sometimes we’re being asked to stop doing something the way we’ve done it our entire lives. It can be done, but it’s hard to do it alone. We really need the support of our medical team.
 
Imagine being told to do better, being told that terrible complications will set in if you don’t do better, and then being made to feel guilty because we couldn’t do better. Our medical teams often don’t hear what is going on outside the exam room -- and if they do, they may often feel they can’t do anything about it. I hear too many stories of patients leaving the exam room angry, guilty, teary-eyed and thinking they’re failures.
 
Now think of that same patient who this time hears: “Here are some things we can work on” or “What can I do to make this easier?” or “How about we try this instead, what do you think?” This inclusive language can help people engage and feel less alone.

Both of you are now looking at the same problem, which is not to see a non-compliant patient or feel like a chronically ill failure.
 
The real problem is that there are forces at work influencing my behavior that my medical team doesn’t understand. And those forces can be minimized only if those of us on both ends of the stethoscope understand what they are and work together to overcome them.

As a patient I have a responsibility to work toward minimizing those forces. And my medical team has a responsibility to help me accomplish those changes and move beyond the failures.

Tags: patient engagement, doctor's appointment, shared decision making
1 comments
Posted: Friday, October 31, 2014

Confronting Health Literacy: Helping Patients Understand

By Geri Lynn Baumblatt, MA, Executive Director of Patient Engagement, Emmi Solutions
Pain is a huge part of the patient experience. And while we can’t eliminate pain, helping patients understand how to talk about their pain, medications, and multimodal treatment can go a long way to improving what people go through both in the hospital and as they transition to home. This has been one of the themes on the Health Literacy Series. Here are a few of the highlights:
 
Another challenge is the role health literacy and patient understanding plays in both over- and under-treatment. Helping people understand and share in treatment decisions can be complex. But the more we think about the short and long term effects on quality of life, and the many human and monetary costs of inappropriate utilization, it’s worth finding ways to help patients understand:
For more like this, check out the 2014 Health Literacy Month Series: The Recap.

Tags: patient engagement, shared decision making
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Posted: Tuesday, September 30, 2014

Asking Questions, Not Just Giving Information: Shared Decision Making is Relational

By Geri Lynn Baumblatt, MA, Executive Director of Patient Engagement, Emmi Solutions
Gonzalo BacigalupeGonzalo Bacigalupe is Professor of the Master of Science in Family Therapy Program and the PhD in Counseling Psychology, College of Education & Human Development at the University of Massachusetts Boston. He is President of the American Family Therapy Academy. Bacigalupe is co-principal investigator of a Patient-Centered Outcomes Research Institute Pilot research project: Influence and evidence: Understanding consumer choices in preventive care.


Because the benefits of cancer screening and its usefulness for a wide group of patients are uncertain and the harms may outweigh the potential benefits, doctors and patients need to engage in shared decision making (SDM). And while this sounds straightforward, it’s often challenging.
 
We’ve both been involved in developing SDM tools to guide breast and prostate cancer screening, Gonzalo with a focus on Latino patients. 
 
Most SDM research is based on the idea that patients make individual decisions. So the focus has been on understanding how patients acquire and make sense of information that’s often packed with statistical, epidemiological, and probabilistic data. And we ask how well people comprehend it. 
 
Missing from this equation is how many people operate not just as individuals but also as one person within a net of family and community relationships. Most Latino patients talk through these decisions not just with their close relatives, but also with their extended family and other significant members of their network. Decisions about prevention, diagnosis, and treatment are not just in the working of their individual minds or a cognitive process, but located in the ecology of relationships.
 
For vulnerable patients, besides having more difficulties at making sense of complex data, the question of how we explore their approach to decision making is central and requires cultural humility.
 
So what can clinicians do?
Ask about patients' social and cultural context and be curious about how they make sense of healthcare decisions. These questions are an example of how we may capture the rich context and story that may play a pivotal role in how the patient participates in the decision making process.
 
I know this is a lot of information, if you were to discuss this with a family member or friend, what would be the outcome of the conversation?
 
What other information do you need to help you make a decision you feel comfortable with?
 
How would these options affect you and your family’s day-to-day life and their ideas about you?
 
The epidemiological or probabilistic data, no matter how attentive is to the literacy level of a specific community, will be meaningless if we do not understand who and what plays a significant role in complex healthcare decisions.

Tags: communication, shared decision making, family caregiver
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Posted: Wednesday, August 27, 2014

Red Light, Green Light: Helping Patients Weigh the Evidence

By Geri Lynn Baumblatt, MA, Executive Director of Patient Engagement, Emmi Solutions

Casey Quinlan, who contributed to this post, is a patient advocate, hospital medicine journalist, citizen scientist, 2013 MedX ePatient Scholar, speaker, writer, and healthcare policy wonk dedicated to putting the patient, and the patient's voice, at the center of healthcare.



Patients and families often have to wade through a flood of information about the latest in medical science. And especially when in the hospital, they often need to try to understand the pros and cons of treatments without time for research and while they’re in pain or recovering from a procedure.

Here’s a tool you can use as you partner with them to help them to understand the evidence: TheNNT.com. NNT = Number Needed to Treat.

The site uses stoplight graphics - red, yellow, and green - to show the scientific evidence of the benefit, or lack thereof, of treatments, diagnoses, and risk assessments. There’s also a black label for if the harms outweigh the benefits. The site authors are all practicing emergency medicine or critical care MDs.

For example: Cardiac defibrillation prevents death in 38% of cases where it’s used (green light all the way); Coronary bypass has no effect on 10 year survival post-heart-attack in 96% of cases (yellow light, needs more study); Aspirin to prevent a first heart attack or stroke has no benefit in 99.94% of cases (red light, don’t bother).

This is just one tool that can augment conversations and help patients and families get a better understanding, so they have fewer deer-in-the-headlights moments when facing treatment decisions.

Tags: patient engagement, shared decision making
0 comments
Posted: Thursday, July 31, 2014

“Be prepared” is more than a catchy boy scout motto, it’s good patient care

By Geri Lynn Baumblatt, MA, Executive Director of Patient Engagement, Emmi Solutions

Stuart S.W. Grande, who contributed to this post, is a post-doctoral research fellow in shared decision-making at the Dartmouth Center for Health Care Delivery Science, interested in the value of new technologies for enhancing the patient voice (patient engagement).

A surprise party can be exhilarating, but waking up from surgery and finding out you can’t drive for 2 to 6 weeks is not. But that’s what happens to many women who are uninformed about recovering from a scheduled C-section. Other women panic when their belly swells up after an abdominal hysterectomy, something they should know to expect, but sometimes aren’t told about.

Setting expectations about recovery doesn’t just help patients prepare, it reduces their stress. After all, when people know to expect things like pain, they usually tolerate it better. And knowing it’s normal for something to look bruised, oozy, and scary can help reduce late-night panicky calls. More importantly, they have a better sense of when something is wrong and should call.

Patients can also be more activated to participate in their recovery. For example, sometimes, like after orthopedic surgery, patients aren’t told about the potential weight gain that comes from being less mobile. While obvious to clinicians, patients often don’t consider weight gain as a side effect. For many athletes, returning to the field of play is painful and hard with no guarantee. In these situations, gaining a few pounds makes recovery feel much worse.

Of course there’s a lot we can do to help set expectations. Be specific, practical, and honest about what they’re going to see and feel. Is something going to look really bruised and upsetting? While discharge may look like normal healing to a clinician, it can be frightening and challenging for people who aren’t used to seeing it, especially on their own body.

When people know what to expect after a medical intervention they can plan and prepare. Caring for them like it was the first time, your patients will be grateful.
 


Tags: patient engagement
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Posted: Monday, June 23, 2014

Strategies to Help Patients Make Medical Decisions

By Geri Lynn Baumblatt, MA, Executive Director of Patient Engagement, Emmi Solutions
Medical decisions are daunting. Just walking people through their treatment options can be time-consuming. But how can we help people think about their preferences and life and make a decision that's right for them?

One approach is providing people with videos or written stories (narratives) of what others chose. After all, stories are more engaging and compelling than throwing a lot of numbers and information at people, but do they help people make good decisions? Researchers continue to take a closer look at the effects of narratives, and unfortunately they seem to cause different types of biases and issues. The issue with narratives may be that they are so compelling. (To read more about recent research on patient narratives visit http://engagingthepatient.com/2014/06/25/patient-narratives-shared-medical-decisions/)

Another approach is to help people "try a decision on." For example, instead of simply asking a woman with breast cancer how she feels about breast reconstruction or a prosthetic, ask her to think through different situations, like how she would feel putting on a favorite dress, changing in a locker room, or wearing a bathing suit. This type of thought exercise may help people get a sense of their own narrative without feeling the emotional tug of someone else's story.

Clearly, we need more research to know what we can do to help people apply their preferences to the often complex matrixes of treatment options, side effects, and treatment burdens. What have you tried in your practice to help people integrate their personal preferences into their decisions?

Tags: patient engagement, communication, personal healthcare, shared decision making
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Posted: Wednesday, May 28, 2014

When Caring for the Family Reduces Patient Stress

By Geri Lynn Baumblatt, MA, Executive Director of Patient Engagement, Emmi Solutions
What do patients experience as they drift in and out of awareness in an ICU?
 
Recently, a couple of long-term ICU patients both described how even when they weren’t fully conscious, the mood of the staff as they moved in and out of their room was still apparent to them. They could tell if people were present or smiling, and how even the one-sided conversations staff had with them were meaningful.
 
One patient also described how he had a very strong sense of his parents’ stress as they kept watch by his bed and how it reduced his stress to hear how the staff was caring for his parents.
 
It's impossible to always be “up,” but care, hospitality, and mindfulness of close family and friends may reduce patient stress, even when we think they’re not aware. After all, while everyone is worried for the patient, their worry is often for their partner and family.

Tags: patient engagement, communication, family caregiver
1 comments
Posted: Monday, April 21, 2014

Looking Out for Family Caregivers

By Geri Lynn Baumblatt, MA, Executive Director of Patient Engagement, Emmi Solutions
A hospital out west recently surveyed people with pancreatic cancer and their family caregivers about their emotional highs and lows over the course of treatment. While the graph of the patients’ emotions looked like a fairly intense rollercoaster ride, the graph of their family caregivers' emotions actually showed higher highs and lower lows.
 
To understate the obvious, family caregivers take on a lot -- not just the physical care, but the emotional stress. And, as this small survey showed, caregivers may actually experience more hope when things go well and more stress and depression when they don’t.
 
More and more hospitals have started offering caregiver classes to try to prevent burnout and help prepare people for what lies ahead. Family caregivers often don't realize what they're taking on and how it will affect their social, emotional, and even physical health. At first, it's sometimes hard to see that it can quickly become a challenge just to leave the house for a few hours to run errands or get a good night's sleep, let alone deal with any mood swings or memory or dementia issues.

These types of caregiver classes can also serve as social support and a way for them to meet others to talk with. What is your hospital doing to help prepare family caregivers so they don't end up a casualty of caregiving?

Tags: family caregiver
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Posted: Tuesday, March 25, 2014

Inviting People to Share in Decisions

By Geri Lynn Baumblatt, MA, Executive Director of Patient Engagement, Emmi Solutions
Last month’s tip examined The Case of the Unfilled RX and involving people in any decisions to start a new medication. And while research shows most people want to be involved in shared decision making (SDM), they may not feel comfortable entering into this new dynamic with a clinician. After all, they may be embarrassed to voice concerns – like if they’re afraid of needles or injections.

And there are people who say they don’t want to participate in SDM. But we also know there’s no way to predict who is and isn’t interested. So the most important thing to do is ask. Even if they aren't up for SDM, everyone needs to be invited. We need to initiate it. And it may take some coaxing to get people to open up about what matters to them. After all, aren’t they supposed to be a good patient and do whatever the doctor says?

That said, I think there’s a way to invite people and help engage even those who are reticent. Try something like this:

“There’s no one perfect treatment for your condition. And there are pros and cons to all of them. So, I can tell you about the options, but I need your help to figure out which treatment is best for you. After all, whatever we choose needs to meet your goals and fit into your life and schedule, or it’s not the best option for you.”

When put this way, I think most people understand they are the ones who have the other half of the information needed to make “the right” decision.

To learn more about SDM, a free PDF of an introductory article is available here.

Tags: patient engagement, personal healthcare, shared decision making
0 comments
Posted: Monday, February 24, 2014

The Case of the Unfilled Rx

By Geri Lynn Baumblatt, MA, Executive Director of Patient Engagement, Emmi Solutions
With medical ads on TV some people go to doctor's asking for a medication they’re sure will cure what ails them. But more often, when a new medication is being prescribed, people are dubious. And they’re not likely to express it aloud. Do they really need it? Maybe their uncle took statins and now has leg pain – a valid point informed by real-life experience. Other times people may feel stigmatized if they need to take a second medication for something like diabetes, and if it’s an injectable, fear of needles is enough for many people to silently decide “no.”

So many reasons to avoid taking a drug, and yet we often assume people are simply non-adherent. But maybe we never made sure they agreed to take it in the first place.

People definitely need to understand what the medication is for and why their doctor thinks they should take it. But if we don’t ask patients about their goals and preferences, we can’t know if they do or don’t want it, or if another medication or treatment might be a better option for their lifestyle. But there’s no way to know without asking. We can’t expect people to feel comfortable volunteering this information. And without inviting patients to share their concerns and preferences, they may just nod, politely put the prescription in their bag, and walk right past the pharmacy.


Tags: patient engagement, communication
0 comments
Posted: Monday, January 27, 2014

Helping Patients Understand the Big Picture

By Geri Lynn Baumblatt, MA, Executive Director of Patient Engagement, Emmi Solutions
When it comes to the big picture of a health condition and how it may affect people’s bodies and lives over time, it’s easy to take what we understand for granted and assume patients and families know, too.

I was recently struck by this while working on a decision aid for End Stage Renal Disease. When we tell people who are newly diagnosed or living with diabetes that over time it can cause kidney problems, do they really understand they may be on a trajectory toward renal disease, dialysis and kidney failure? Or do we simply say it can cause “serious problems” and take for granted they know what lies ahead? I think it takes a lot of people by surprise – and it’s not a nice one. In fact, we often begin our interviews of patients who are starting treatments like dialysis with what they wish they’d known.

A local nephrologist told me that as many as 30% of their first-time appointments never show up, because people with diabetes have no idea why they’ve been referred. We heard this from patients themselves in our Crohn’s Disease focus groups. We were concerned all the information about ulcers and anal fistulas was too scary and overwhelming. But what we heard is: this is the real information I wish I’d understood when I was first diagnosed.

Now, I’m not talking about “scaring people into being good patients,” or getting into all of this when someone is first diagnosed. Overwhelming people is not helpful. But making sure they understand enough about their condition and how it may progress can feed into why they’re being asked to do so much day-to day care. And it can help their family engage in their care, too.  

Tags: patient engagement, communication
0 comments
Posted: Monday, December 23, 2013

Baby Steppin'

By Geri Lynn Baumblatt, MA, Executive Director of Patient Engagement, Emmi Solutions
Baby steps, goal setting, action planning … you may have heard of one or all of them. So instead of giving people an overwhelming list of all the changes they should make to their diet, lifestyle, and activity, this is a great way to help people make changes by taking baby steps. Give it a try.

Start by letting the patient make the decision about making one small, achievable goal they feel they can do that week. After all, when we are empowered to choose what we want to change and how, we’re a lot more likely to do it versus being told.

Then be prepared for pretty much any answer. If someone says they want to work on getting more exercise, ask exactly what they’d like to do first. Doctors have heard everything from: I need to clean my living room this week so I have a place to exercise, to I’ll walk 3 blocks, to I’ll do 100 push-ups everyday.

But how confident are they that they can almost certainly do it that week? Ask “on a scale of one to 10, how sure are you that you’ll be able to do this?"

Generally if people say anything less than seven, they need to set a more attainable goal or problem solve what they can do to improve their confidence so it’s in the high zone. Then follow up in one week to find out what they did.

Instead of being overwhelmed by everything they could do, people make a small change and gain confidence that they can change. And they’re usually encouraged and build on that success.

Like anything new, even something as simple as helping a patient set their first goal can be awkward. But like any procedure you’ve learned, it gets easier. And clinicians find they can do it in as little as two minutes.

If you want to learn more, people like Dr. Kate Lorig and Dr. Hilary Seligman have done great work on this: http://www.healthliteracy.com/article.asp?PageID=6111 & http://www.jabfm.org/content/19/3/324.long.

 

Tags: patient engagement, communication, doctor's appointment, shared decision making
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Posted: Wednesday, November 20, 2013

Don't Forget "The Why"

By Geri Lynn Baumblatt, MA, Executive Director of Patient Engagement, Emmi Solutions
I don’t know about you, but I don’t tend to blindly do things just because someone tells me to. Yet we expect patients to do this all the time -- and when they don’t we brand them “non-adherent.” We all have that inner 3-year old that just wants to know “why.” But more than curiosity, we need to make sense of the information.

And when we don’t give people “the why,” or assume they already know why, they will fill in the blank on their own. Take this real example: a bariatric patient is told not to eat or drink 8 hours before his surgery. No reason. Just do it. He shows up having had breakfast. When asked why he didn’t follow instructions, he says “Oh, I thought my doctor just wanted me to start dieting.”

This person is not stupid, he was just trying to make sense of seemingly meaningless orders. A story closer to home: a friend of mine didn’t heed instructions not to smoke in the days after oral surgery. Only after a dry socket developed did the oral surgeon explain that smoking both affects healing and that any kind of sucking action, including cigarettes, and not just through straws, can dislodge the blood clot. Once back home and in pain she said, “Well, if I had known that, I wouldn’t have smoked.”

Tags: communication
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Posted: Wednesday, October 23, 2013

Talk About Myths

By Geri Lynn Baumblatt, MA, Executive Director of Patient Engagement, Emmi Solutions
Big foot and the Loch Ness Monster aside, there are lots of myths and half-truths floating around healthcare. After all, if you’re breastfeeding there’s no possible way you can get pregnant, right?

Of course, you can wait to see if patients ask you about things like this, but chances are they may not realize something’s a myth, or a partial myth, especially when many things sound like common sense. Why would anyone doubt if bed rest is a good idea for low back pain? It certainly sounds right.

Plus, real experiences can reinforce myths. Many people still think the flu shot will give them the flu because they didn’t feel great the next day. They probably didn’t actually have the flu, but it still might mean they’ll avoid getting vaccinated for the next few years.

With something like breastfeeding it can just mean validating that it may play a role in preventing pregnancy, but it doesn’t guarantee a woman won’t get pregnant. For something like low back pain, it may be more challenging to help people understand that even though walking may hurt, that blood flow is important for their back to heal.

But proactively talking about common myths, and talking about them respectfully, can make all the difference in patient understanding.

Tags: patient engagement, communication
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Posted: Friday, September 20, 2013

Be Psychic

By Geri Lynn Baumblatt, MA, Executive Director of Patient Engagement, Emmi Solutions
That’s right, when telling people about a procedure or a new diagnosis, it helps to be a little bit psychic. To be fair, you don’t actually have to be psychic, so much as seem psychic.

You probably already know the questions, fears and worries patients have around certain procedures or diagnoses: When is it okay to have sex again? Will my scar be noticeable? When can I drive again?

These questions weigh on people’s minds. And it may even be hard for them to concentrate on anything else you say until they get an answer. Sometimes they feel embarrassed to ask because they have a question about something like ED or depression medication, other times they’re embarrassed that what they’re worried about is something cosmetic, like a scar. Or it’s the real day-to-day concerns about being able to care for their family.

So, if they don’t bring it up themselves, normalize those questions with a simple "now with this procedure, a lot of people ask…" It’s amazing the relief they feel to know they’re not the only ones with this question and that they didn’t have to be the one to bring it up.

Tags: patient engagement, communication, doctor's appointment
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