You are busy clinicians practicing in a hospital today and this term “patient engagement” is driving a lot of discussion and initiatives to demonstrate your patients are “engaged”. In fact, you are indirectly measured on this in the HCAPS. I would like to challenge the use of the term because it has no standard definition in healthcare, which means it is being driven by individual perceptions.
Let’s visualize how this could play out in a cartoon like, Calvin and Hobbs or The Far Side. Calvin tells his pal Hobbs, “The doctor said my gage ended but I didn’t have a gage did I?” or Gary Larson’s The Far Side characters want to know why they have to get married to their doctors.
If we look at Webster’s for a definition of engaged, it is a formal agreement to get married or an arrangement to do something or be somewhere at a fixed time. “I have a dinner engagement.”; “Susan is engaged to be married.” Both of these expressions are commonly understood use for the term engaged.
So how are we interpreting “patient engagement”?
Clearly, the culture of clinical care is changing and patients and families need to be central to our plan of care because a good plan of care is based not only on the treatments, medications and procedures but also on how all of this affects the life of the patient. We have to tailor the plan to fit the person for whom we care. This can be a challenge today because many patients have multiple problems and treating the admitting diagnosis alone is rarely an option, and there is never enough time to do everything you want to for your patients.
The Story of “Uncle Bill”
Uncle Bill is 82, lives alone in a second floor apartment without an elevator, has type II diabetes and his admitting diagnosis is CHF. He cooks for himself but it is often soups and boxed meals. His vision is deteriorating because he also has macular degeneration in his right eye, and his hearing is decreased but he does not use a hearing aid. He is distressed because his cat of 12 years is alone in the apartment with no one to feed him. He wants to go home. He has no children, and his sister lives out of state and has health problems that prevent her from helping him. This is his second admission for CHF in two months.
This man needs our time to care. Time to listen so we can develop a plan that will help him remain in his home. Quick fixes are not possible for this type of patient, but we are being driven to make things happen quickly and efficiently…all with the results of good outcomes and HCAPS results.
Engaging someone like Uncle Bill is an example of how we can perceive the term “patient engagement” differently. I suggest the term in this situation means that we address his medical and human needs so there is a plan of care that works for him. It is one thing to provide him with an accurate scale so he can do a dry weight in the morning, but the scale needs to have very large numbers that he can read because of his degenerating eyesight. This will help us manage his medication but we must find follow on help for him to improve his nutrition. And does he have sufficient social support? Isolation is a big negative for anyone, especially elders living alone. Arranging the right home follow up for Uncle Bill may open some options for him and improve his ability to manage his health better.
The term patient engagement is here to stay despite the variations in perceptions of its meaning. But it will never achieve the purpose of caring for a human being with very real needs without clinicians having the time to listen, to understand, and design a plan to support those needs.
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