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Patient Engagement Tip of the Month

Geri Lynn Baumblatt, MAGeri Lynn Baumblatt MA, For the last 20 years, Geri has worked to help people understand health conditions and procedures, orient them to their diagnoses, make more informed decisions about their care, and partner with their care teams.  She oversaw the creation of the Emmi program library, and she regularly speaks and serves on patient engagement, patient experience, health literacy, shared decision making, health design, family caregiving, and heath communication panels for organizations like AHRQ, the Brookings Institute, Stanford Medicine X, and the Center for Plain Language. She serves on the editorial board for the Journal of Patient Experience, is on the board of the Society for Participatory Medicine, and published a chapter in Transformative Healthcare Practice through Patient Engagement (IGI Global). She currently consults on patient engagement, family caregiving, and health communication. Follow her on Twitter @GeriLynn


Showing all Blog Posts with tag: expectations View All Blog Posts
Posted: Monday, April 01, 2019

When Your Own Health is the Best Medicine for Patients

By Geri Lynn Baumblatt & Shiv Gaglani

Clinicians and professional caregivers aren’t used to being on the receiving end of care -- and typically don’t like the vulnerability that comes with being a patient. Instead they’re often taught to be tough. They work long hours, eat on the go, and balance life and death decisions - in order to deliver care to others. In other words, the culture of medicine is to not care for yourself in as you work to care for others. It’s a zero-sum game. Every minute spent getting rest, eating well, enjoying a hobby, or exercising is a minute that’s not spent doing patient care.
 
What if it’s not a zero-sum game?
There's ample evidence that how doctors look, feel and behave may affect patient care. Studies show that many doctors and nurses fail to promote healthy behaviors in their patients, particularly if they themselves aren’t eating well, getting exercise and are stressed. And who isn’t stressed?
 
The converse is also true:
Clinicians who are healthier are more likely to talk with their patients about lifestyle choices and patients in turn may feel more comfortable receiving and following their advice.
 
So much of health care spending and disease burden is tied to behaviors: smoking, diet, activity, and stress. And if the ones who provide care can't make changes in their own lives, can we expect patients to make those changes?
 
A Johns Hopkins study found that normal weight doctors are more likely to counsel their patients about obesity and weight loss than physicians who are overweight. Today, roughly 6 in 10 doctors and nurses are overweight or obese, a level approaching that in the general population. That’s not great news, but it’s also an opportunity.
 
Consider the dramatic decline in smoking rates over the past 50 years. Clinician behavior helped lead the way. In the 1950s about half of physicians smoked. By the 1980s the rate was below 20%. Today its down around 3%. In the culture of healthcare, being a smoker became unacceptable, and the clinicians who quit smoking themselves knew what it took to quit and could help patients get over the hump.
So even though doctors may make lousy patients, embracing that experience might be exactly what they have to do to help their patients get over their own hurdles, vulnerabilities, and fears.
In the words of Nobel Peace Prize-winning physician Albert Schweitzer: "Example is not the main thing in influencing others. It is the only thing."
 


Make a promise to yourself and those you care for.
If this resonates with you, read more about The Patient Promise. Commit to your own health and creating the best version of yourself, so you can help others do the same.  

 

Here is a youtube video link that nicely complements this article: https://www.youtube.com/watch?v=3fS3CCZwrc0



 
Shiv Gaglani began his MD degree at Johns Hopkins and paused to earn his MBA from Harvard in 2016. He co-developed the Patient Promise, a movement to improve the clinician-patient relationship through partnership in pursuing healthy lifestyle behaviors, and curated the Smartphone Physical, which debuted at TEDMED. He is also the co-founder and CEO of Osmosis.org, a health education platform that reaches over a million current & future clinicians, as well as their patients. @ShivGaglani @OsmosisMed



Geri Lynn Baumblatt MA, For the last 20 years, Geri has worked to help people understand health conditions and procedures, orient them to their diagnoses, make more informed decisions about their care, and partner with their care teams.  She oversaw the creation of the Emmi program library, and she regularly speaks and serves on patient engagement, patient experience, health literacy, shared decision making, health design, family caregiving, and heath communication panels for organizations like AHRQ, the Brookings Institute, Stanford Medicine X, and the Center for Plain Language. She serves on the editorial board for the Journal of Patient Experience, is on the board of the Society for Participatory Medicine, and published a chapter in Transformative Healthcare Practice through Patient Engagement (IGI Global). She currently consults on patient engagement, family caregiving, and health communication. Follow her on Twitter @GeriLynn
 


Tags: personal healthcare, expectations, experience, patient
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Posted: Monday, March 04, 2019

More Than a Nuisance: Addressing Post-op Depression as an Essential Part of Recovery & Participation

By Geri Lynn Baumblatt
Recently, a friend had a minor surgery. Once he was safely home, he was surprised that he burst into tears. This was transient, but that’s not always the case. 
 
Over the past year as I’ve talked with people about a variety of procedures, and one story repeated: even when people were looking forward to something like a joint replacement so they could be more active again, they were often confounded to find themselves depressed in the days, weeks, and even months after surgery. As one woman told me, “I was relieved to finally have a hysterectomy to stop my bleeding. I definitely didn’t want to have more kids. But afterward, I was seriously depressed, and even had suicidal thoughts. I couldn’t understand why. But I felt like I was going crazy.” 



We know it’s normal for people to feel anxious before surgery, but do we help them understand that some people experience depression afterward? 
 
People expect pain and other challenges during recovery, but for those who also experience depression, not knowing this can happen creates confusion, embarrassment, and isolation.
 
Depression has been documented after many procedures coronary artery bypass graft, joint replacement, bariatric surgery, colon surgery. While it may be more common after certain procedures, there’s a risk with any surgery. And getting comfortable with identifying and addressing it can only improve patient experiences, engagement and outcomes.
 
Many factors may contribute: the body has been through a trauma (even if a planned trauma), effects of anesthesia, a post-op let-down effect, opioids, poor sleep, and depression or anxiety before surgery.
 
Unfortunately, not knowing it occurs makes it less likely people will reach out for help when they experience it. And:
  • This makes it much harder for them to participate in their recovery and rehab.
  • It lowers their threshold for pain, and can create a pain-depression feedback loop.
  • It increases morbidity and mortality.[1, 2]
Get out ahead of and behind it:
  • Studies recommend screening everyone for depression before procedures. This could also be used as an opportunity to both broach the topic with people and normalize it. [3]
  • Educate patients and family caregivers about post-op depression so they can recognize it, report it, and put it in perspective.
  • Help people understand what happens during surgery and set realistic expectations about recovery. Knowing what to expect reduces anxiety and gives people a sense of control. And less anxiety before surgery may mean less afterward.
  • Screen for depression during follow-up visits and calls. 
People can only participate in their care when they have energy; unfortunately, depression robs them of this. And including it as part of patient and family education can help people identify it, destigmatize it, and address it.  
 
 

Catch up with Geri this Spring at:

 
1. Guerini F, Morghen S, Lucchi E, Bellelli G, Trabucchi M. Depressive symptoms and one year mortality among elderly patients discharged from a rehabilitation ward after orthopaedic surgery of the lower limbs. Behav Neurol. 2010;23:117–21. doi: 10.1155/2010/365341. [PMC free article][PubMed] 
 
2. Thombs BD, de Jonge P, Coyne JC, Whooley MA, Frasure-Smith N, Mitchell AJ, et al. Depression screening and patient outcomes in cardiovascular care: a systematic review. JAMA. 2008;300:2161–71. doi: 10.1001/jama.2008.667. 
 
3. Ghoneim, M. M., & O'Hara, M. W. (2016). Depression and postoperative complications: an overview. BMC surgery16, 5. doi:10.1186/s12893-016-0120-y 



Geri Lynn Baumblatt MA, For the last 20 years, Geri has worked to help people understand health conditions and procedures, orient them to their diagnoses, make more informed decisions about their care, and partner with their care teams.  She oversaw the creation of the Emmi program library, and she regularly speaks and serves on patient engagement, patient experience, health literacy, shared decision making, health design, family caregiving, and heath communication panels for organizations like AHRQ, the Brookings Institute, Stanford Medicine X, and the Center for Plain Language. She serves on the editorial board for the Journal of Patient Experience, is on the board of the Society for Participatory Medicine, and published a chapter in Transformative Healthcare Practice through Patient Engagement (IGI Global). She currently consults on patient engagement, family caregiving, and health communication. Follow her on Twitter @GeriLynn
 
 

Tags: patient engagement, communication, patient education, expectations, experience, patient
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Posted: Wednesday, January 02, 2019

Behind Worry Lines: Anticipating Patient Concerns

By Geri Lynn Baumblatt MA
“Will a colonoscopy hurt if I have a hemorrhoid?”
 
“Will a hip replacement make it possible for me to have sex again without pain?”
 
“What happens to the space where my uterus was?”
After reading a brief description of how organs in the body shift to fill in the space, the woman (who had a hysterectomy many months ago) was thrilled. “No one explained that to me.” she said. “And it’s really been bothering me. This puts my mind at ease.”

BehindWorry.jpg

As much as we encourage people to prepare questions, they know there’s limited time. And they feel like questions about things like scars will come off as vain, or they’re embarrassed to ask questions about things like bowel movements or sex. Sometimes just knowing the answer is reassuring. Other times, issues like hip pain during sex is one of their main reasons for having a procedure. In fact, most people want more info about sex after hip replacement.
 
Even confident people who interview scientists for a living don’t feel comfortable asking questions when they’re in the patient’s seat. On an episode of the podcast Hidden Brain, Alan Alda describes being flummoxed and afraid to ask questions about oral surgery he’s about to have. It ends up affecting his smile, something he wished he’d understood as an actor.
 
While we can’t anticipate all questions, we can anticipate many of them. And this does a few things:
  • It normalizes asking uncomfortable questions. If you bring up questions about sex, hemorrhoids, or scars, people realize these must be common questions others have. It puts them at ease, and they feel more comfortable asking other questions.
  • It lets them know you care about them and their concerns. They’re often incredibly grateful. It builds the relationship and can foster more intimacy.
  • It can make the conversation more efficient – people don’t spend time dancing around their questions, building up courage, and figuring out how to broach a topic.
  • It builds trust. When people see their caregivers get it and know what concerns them, they’re more likely to trust other information.  
  • When you answer questions up front, they not hanging over people. So this can make it easier for them to focus on the rest of the conversation.
How do you learn about and capture patient and family concerns?
If you haven’t done this already, try it, see what you learn, and then notice how integrating it into conversations changes them.


Baumblatt1.jpg
Geri Lynn Baumblatt MA, For the last 20 years, Geri has worked to help people understand health conditions and procedures, orient them to their diagnoses, make more informed decisions about their care, and partner with their care teams.  She oversaw the creation of the Emmi program library, and she regularly speaks and serves on patient engagement, patient experience, health literacy, shared decision making, health design, family caregiving, and heath communication panels for organizations like AHRQ, the Brookings Institute, Stanford Medicine X, and the Center for Plain Language. She serves on the editorial board for the Journal of Patient Experience, is on the board of the Society for Participatory Medicine, and published a chapter in Transformative Healthcare Practice through Patient Engagement (IGI Global). She currently consults on patient engagement, family caregiving, and health communication. Follow her on Twitter @GeriLynn

 
 

Tags: communication, patient education, expectations, engagement, patient
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Posted: Monday, August 06, 2018

Making it Click

By Geri Lynn Baumblatt, MA
I spend a lot of time in hospitals, but it’s not where I was planning to spend Memorial Day. An older relative hit her head ad broke a couple of ribs – and so there we were.
 
I sat in the room as a nurse explained how and when to use the incentive spirometer to prevent pneumonia. Then something simple, yet amazing happened. He took an extra minute to explain that the pain of the broken ribs would prevent her from taking full breaths. And how using the spirometer to take deep breaths in would expand more of her lungs. That way, those small air sacs in her lungs wouldn’t collapse, fill with fluid, and get infected.
 
It was like hearing the last puzzle piece snap into place.
 
She got it, she understood the importance of the deep breaths, how her participation is what would make the difference -- and she was on it. She even started to explain it to the doctor when he came by.


 
We often THINK we’re connecting the dots for people. But are we giving them what they need?
 
Is it enough to tell people an incentive spirometer will prevent pneumonia? Probably not. I don’t think it’s about giving a full A&P lecture – but enough information to give people that insight into why and how – so their brain gets it.
 
I’ve been working with patients and family caregivers to ensure they understand what they can do before and after surgeries (like joint replacement) to recover well:
 
  • Get up and walk
  • Stop using nicotine in the weeks before and after surgery
  • Avoid opioids

 
Obviously, people want to have a smooth recovery. And I kept explaining one of the reasons these things help with healing are because they improve blood flow. But most people were still a bit stymied. They think of their bones as needing calcium, but not blood. It seems like a different system. It just wasn’t clicking. So starting with a little more on how the bones need blood put that extra piece in place so it made sense.
 
People were surprised and confused by the recommendation to get a dental checkup before joint replacement surgery. Telling people that gum disease or things in their mouth could lead to an infection in a hip or knee joint didn’t resonate. But explaining that any bacteria in their mouth could travel through their blood to their new joint helped it come together.
 
Are there best practices or instructions people rarely follow?  
If so, take a step back and ask why it isn’t clicking for them. What’s missing in the explanation to them that we often take for granted? We forget what it’s like not to know the why or how of so many things we ask people to do.
 
Share your insights where you’ve seen it click for patients and families.
 

 



Geri Lynn Baumblatt MA,
For the last 20 years, Geri has worked to help people understand health conditions and procedures, orient them to their diagnoses, make more informed decisions about their care, and partner with their care teams.  She oversaw the creation of the Emmi program library, and she regularly speaks and serves on patient engagement, patient experience, health literacy, shared decision making, health design, family caregiving, and heath communication panels for organizations like AHRQ, the Brookings Institute, Stanford Medicine X, and the Center for Plain Language. She serves on the editorial board for the Journal of Patient Experience, is on the board of the Society for Participatory Medicine, and published a chapter in Transformative Healthcare Practice through Patient Engagement (IGI Global). She currently consults on patient engagement, family caregiving, and health communication. Follow her on Twitter @GeriLynn
 


Tags: patient engagement, communication, patient education, expectations, experience, healthcare
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Posted: Tuesday, January 24, 2017

Do Your Patients Know What's in it for Them? Articulating the Value of Patients First

By Frieda Wiley, PharmD, BCGP, RPh, is a board-certified, geriatric pharmacist and medical writer whose healthcare experience includes the pharmaceutical industry, community pharmacy, and managed care consulting. She has served on the editorial board for the American Association of Consultant Pharmacists, as Chair and Co-Chair of the American Pharmacists Association’s Medication Management Special Interest Group for Telehealth, and is a member of the University of Texas at Houston Consortium of Aging Committee. @Frieda_Wiley


By Geri Lynn Baumblatt, MA & Frieda Wiley, PharmD, BCGP, RPh

When Frieda first began practicing as a pharmacist in managed care, she called a patient (we’ll call her “Monica”) to conduct a review of her medications. Monica was on the verge of hanging up until Frieda asked, “Have you recently been experiencing any bleeding or bruising?”
 
Monica paused and said, “You know, come to think of it, my gums do bleed whenever I brush my teeth. Could one of my medications be causing that?”
 
Frieda knew she’d recovered from what would have been an epic patient engagement fail. Instead, she used that 15 seconds to establish credibility, value, and concern, but most importantly, to get at why a medication review was meaningful for Monica. She picked a common side effect that would instantly grab Monica’s attention. Otherwise, the call might have been seen not as a service, but a nuisance — a call to update records. Or Monica may have suspected the call was gathering information to see if her insurance should keep paying for her medication. But a “medication review” didn’t immediately sound like something that would benefit her.
 
Articulating Value Up Front
We often assume patients and families know why we’re asking them certain questions or to do certain things: We repeatedly ask them about pain levels, tell them to avoid salt if they have heart failure, or recommend caretakers rotate bedridden patients frequently. But the value we recognize and take for granted is often not immediately obvious to patients, and that makes it even more important that we, as provider, articulate those benefits up front.
 
Even when a patient is admitted and we ask them to repeat and confirm information, patients often don’t see the value. Instead, the repeated questions can seem annoying or even incompetent. But opening the conversation with, “To make sure we’re keeping you safe, I’m going to re-ask you a few questions…” can shift patients' reluctance to cooperation and trust.
 
How can we present ourselves as approachable?
There is no cookie-cutter approach to establishing rapport. A tactic like the side effect question can quickly engage a patient who otherwise might not see a medication review as beneficial; but there are other ways.
For example, whenever a patient mentions a hobby or activity, take a few seconds to document it. At the next visit, follow up with them about that personal detail. “Last time I saw you, you were spending a lot of time in the garden; how is it looking now?” Better yet, relate it back to their health. “Last time I saw you, you were doing a lot of gardening, but your arthritis was getting in the way. How is the garden looking? Are you able to spend more time working on it now that you started the new medication?”
 
Reframing this question into a more insight format kills two birds with one stone. Not only can a provider further improve patient rapport by demonstrating compassion and insight, but it creates an opportunity to develop a more open and fluid dialogue. And in a world where providers are pressed for time to connect, this can go a long way.

Tags: patient engagement, communication, family caregiver, empathy, health literacy, expectations, engagement, experience, healthcare, listening, patient
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Posted: Tuesday, December 20, 2016

The Expectation/Experience Gap

By

Co-author: Carly Thanhouser

Even though clinicians have great insights, if they haven’t gone through it, there’s only a partial understanding of the lived realities. Interestingly, as patients become more and more active in their care, they have higher expectations of the care that they will receive.  >>>


Tags: patient engagement, empathy, patient education, expectations
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