Health is Primary: Engaged Patients Are Healthier Patients

Family Physician Says Patient Accountability Builds Engagement

December 07, 2016 03:18 pm Chris Crawford

An Annals of Family Medicine article(www.annfammed.org) from 2008 looked at how patients' commitment to, and trust in, the patient-physician relationship affected their willingness to adhere to medical advice. After analyzing survey data from more than 850 patients, researchers found a positive association between this trust and commitment and patients' adherence to healthy eating behaviors recommended by their physician.

[Doctor with senior female patient in exam room]

These findings simply suggest if patients trust their family physician and are committed to the patient-physician relationship, they are more likely to follow advice and recommendations that are good for their health.

For December, the Health is Primary(healthisprimary.org) campaign from Family Medicine for America's Health(fmahealth.org) is focusing on this topic -- engaging patients to take an active role in their health care. Among resources the campaign is offering is an infographic(www.healthisprimary.org) on putting patients at the center of care, relevant posters(healthisprimary.org) and a December calendar that includes facts and sample tweets family physicians can use to amplify Health is Primary's "focus on health" message.

Establishing Relationship Helps Engage Patients

As the Annals of Family Medicine article suggested, patient engagement doesn't happen without a patient's full commitment to the patient-physician relationship.

Story highlights
  • For December, the Health is Primary campaign from Family Medicine for America's Health is focusing on engaging patients by putting them at the center of care.
  • The campaign is offering a toolkit that includes an infographic that focuses on putting patients at the center of care, relevant posters and a December calendar that includes facts and sample tweets family physicians can use to amplify Health is Primary's "focus on health" message.
  • Family physician Gregg Stefanek, D.O., of Gratiot Family Practice, Alma, Mich., told AAFP News he emphasizes patient responsibility in his practice.

Family physician Gregg Stefanek, D.O., of Gratiot Family Practice, Alma, Mich., part of the Covenant HealthCare group, told AAFP News he tries to make patients feel comfortable before he jumps into a discussion of their health issues.

"I also try to understand them," he said. "Everyone is a product of the love they have or haven't received. One of the basic human needs is to be understood. If patients feel like I care enough to try to understand them, then I'm in a much better place to be able to influence them."

Stefanek said he starts with small talk, such as about a patient's dress or a recent sports game. "Sometimes I talk about their family, which is much easier to do being a family practitioner because I often know much about their family," he said.

The power of humor shouldn't be overlooked as a great tool to help patients relax and be comfortable, Stefanek advised. "They more readily open up and are willing to change when we laugh together," he said. 


And don't forget it's important to encourage staff to smile and treat everyone with the kindness and respect they deserve. "A lot of our patients are coming from very dark places," Stefanek said. "Labeling them as 'noncompliant' or uninterested in their own care does them a disservice and prevents baby steps toward a more powerful interaction."


Encouraging Patient Responsibility Leads to Engagement

At Gratiot Family Practice, patient responsibility is emphasized, and this starts with a mandatory orientation session for all new patients, said Stefanek.

"It's made clear at this session that a patient's health is their responsibility, and we challenge them from day one to be an active participant in their health," he explained. "We think this is an integral part of how we are changing the culture of our entire practice."

Stefanek also has established a patient advisory panel to solicit information from patients on how well the practice is serving their needs and what it could be doing better. Again, a guiding principle of this panel is patients taking more responsibility for their own health.

"In the past, physicians have never really given patients the permission to do this, nor have we challenged them to 'step up their game' and be the ones who care most about them being healthy," he said.

Stefanek said the clinic's patient portal allows patients to access him directly and supports his philosophy that he is there to help them take care of themselves.

"I tell all of my patients that it's not my job to keep them healthy," he said. "It's their responsibility with my and my staff's support.

"I believe our efforts are paying off, and we are gradually changing the whole culture of my practice by promoting this new type of engagement."

Stefanek pointed out that it takes complete buy-in from staff to promote patient responsibility. He said the clinic's staff is good at encouraging, and sometimes demanding, that patients bring their blood pressure and blood sugar readings with them to visits, know what medications they are taking and what for, and remember when their next screening and follow-up tests are due.

Engaging Patients Is Valuable for Adherence

The more patients are engaged in improving their health, the better they will adhere to medical advice and adopt healthy behaviors.

Stefanek said a good example of the value of patient engagement is with medications. "It's no longer acceptable that patients don't know what they are taking or what the medications are for," he said. "We are now insisting that they, to the best of their ability, take ownership of their medications."

Being engaged can also greatly benefit patients in discussions about necessary -- and unnecessary -- testing. "Patients need to ask whether the test is necessary, the expected benefits, the possible adverse consequences and how the test will change what we might recommend," said Stefanek.

If a patient refuses to be engaged in the promotion of their health, they simply will not receive the best care possible.

"They will be subjected to more risk, duplicate unnecessary testing and miss out on the opportunity to thrive as they get older," Stefanek said.

Stefanek added that patients who refuse to be engaged in their health create more work for clinics -- reminding them of services they may need and spending more time coordinating their care and on patient education.

He said he encourages patients to go online and learn as much as they can about their own health -- the conditions they have and the steps they can take to improve their health.

"My experience is that when patients do this, the interactions we have are much more productive," Stefanek said. "Most of the time, this has resulted in them not demanding tests or services that aren't needed, and often, it has given them an understanding and comfort level to not do more testing."

Patients miss out on this empowerment if they refuse to be engaged, he pointed out.

Another major benefit of this approach, according to Stefanek, is that it has energized him and his staff and helped prevent burnout.

"No longer do I feel the entire weight of trying to force my patients to be healthy," he said. "Now it's more of a partnership where we share the burden and the excitement of working toward something better." 


Related AAFP News Coverage
Health is Primary Campaign Focuses on Caregiver Health
Family Physicians Work to Support the Support System

(11/9/2016)

Health is Primary
October Campaign Is All About Championing Primary Care

(10/12/2016)

President's Message
Health is Primary Building Support for Strong Primary Care Foundation

(9/19/2016)

More From AAFP
Frequently Asked Questions on Patient Self-management(2 page PDF)