Based on the NEJM Catalyst survey regarding the differences between initiating and maintaining behavior change, in-person social support (followed by virtual social support) ranked the highest in sustaining long-term behavioral changes. Members of the council who participated in the survey believed that continued and consistent contact with patients influenced sustainable changes. The combination of human interaction plus digital tools reinforcing the relationship appear to be the best strategy. Even though there has been a gradual shift away from the fee-for-service culture, it still seems impractical for physicians to invest even more time into patient engagement given current constraints of the healthcare system (e.g. clinicians rarely have enough time to get through all the evidence based teaching necessary let alone focus on other factors seemingly non-clinical). Clinicians often give up motivating and influencing their patients, especially after they see marginal gains (or lack thereof) over the course of several years with patients who have chronic illnesses. You have burned out and cynical clinicians on one hand and patients who love inertia on the other. The irony is that if clinicians were to spend more time towards patient engagement, then there would be more impetus for patients to self-manage and be more accountable in their care and outcomes. Research has demonstrated that patient engagement leads to better health outcomes and reduces overall costs. Ultimately, patients being active participants in their healthcare leads to sustainable, long-term behavioral changes. In order to practice medicine effectively, efficiently, and to allow patients to extract the most out of the healthcare services they receive, clinicians should make attempts at patient engagement in a more deliberate manner with different strategies:
- Model after other human service businesses
One of the reasons that luxury car dealerships, financial planners, and boutique firms across a range of industries are so effective with their clientele is due to their shameless persistence in engaging with their customers. They seem to be very regimented in their follow-up without it appearing overly contrived. What if clinicians could adopt that kind of style with their patients? A combination of phone calls and digital contact seems appropriate – even leaving a voicemail in the evening as follows could signal enough persistence: “I sent you an email asking you if you’ve ever been tested for Thalassemia about a week ago– I think you are iron deficient for other reasons, but I want to make sure we’re covering all our bases for your condition. If I don’t hear from you this week, I’ll be discussing this with you at your next appointment in 2 weeks.”
- Blend a style between a motivational coach and psychologist
Motivational coaches who are very effective typically try to leverage emotional vulnerabilities and emotional language in very explicit ways to enforce change. Psychologists tend to non-judgmentally allow clients to form conclusions by themselves. Clinicians are often balancing these two approaches to avoid both paternalism as well as the snail-paced results of motivational interviewing. Language could be blended, with elements of idealism and also allowing for patient autonomy: “The pain of discipline is nothing compared to the pain of regret. You’ve recently had a lapse, but if you stick with the diet that you initially were so good with, what do you think it will do for your diabetes? Can you imagine what life will be like?”
Clinicians are never at risk of overinvesting in communication skills, as this is necessary to strike the right balance in influencing patients over the long-run. They would benefit from practices and processes in other industries where contact is consistent and maintained over a continuum with the assistance of digital technologies.