Bob Abrahamson, Chief Marketing Officer
My tonsils were removed when I was around 7 years old. The two things I remember most were staying overnight in the hospital. I was pretty scared. And a lot of talk about ice cream that I was too sore to enjoy. Why were my tonsils removed? Because the pediatrician told my parents to do it. This was classic paternalistic medicine. Note: with no ill intentions or outcomes. The doctor was doing his best to provide “Care to” the patient.
Fast forward about 15 years and I was trying to figure out the next best course of action for a recurring dislocated shoulder injury. The orthopedic surgeon recommended surgery. Upon probing I discovered a long rehab ahead with a decent likelihood the reinjury could still occur. I decided against the surgery and the doctor, with reservations, wrote me an Rx for physical therapy. Happily, it all worked out. In retrospect, this is an example of “Care for” the patient. The doctor was honest if not forthright (he answered my questions but didn’t present all options completely at first blush) and ultimately honored my preferences. He provided “care for” with less than optimal patient engagement.
Thirty years later and my teenager keeps getting strep throat. Over a period of a couple of years we finally landed on the T&A surgery I had at a much younger age. It was far from smooth. We were warned that recovery for a teen could be difficult, but we didn’t anticipate a 3-night stay in the hospital. Despite the complications (and in the end all was OK), this experience was a situation where the providers (and I include multiple doctors, nurses, and other support staff) really provided “care with” the patient. From decision making through various treatment options to an ultimately difficult recovery, the care team was consistently listening and collaborating with us. Understanding where my child was coming from, clearly and compassionately providing options along with their recommendations, and supporting us every step of the way.
I recently discovered the “Care To” “Care For” and “Care With” construct while doing some patient engagement research. It resonated with me. I like how it reflects the evolution toward collaborative care in consistently positive terms. Providing “care to” the patient sounds much nicer than being “paternalistic.” It’s also an enhancement to patient centricity. Impactful patient engagement is a 2-way street. Research informs that the patient’s relationship with the doctor is a key ingredient in shared decision making. Collaborative care where preferences are honored and understood by providers who are still encouraged to openly express their opinions, without pushing, is the ideal in my mind.
“Care With” Technology
“Care With” requires the human touch. Yet, it can be supplemented by technology. Some of the key factors impacting collaborative decision making include:
• Care Experience
• Diagnosis and health status
• Type of decision to be made
• Amount of knowledge about diagnosis
• Attitude towards participation
• Patient-provider relationship
• Perceived inadequacy/self-efficacy
• Health literacy
• Locus of control
In some cases, it is readily apparent how technology can impact these factors. For example, providing credible and professionally created patient education, in a variety of formats during the health journey can address issues of knowledge along with health literacy.
Digging in deeper, by using technology to:
1. Proactively inform patients of next steps and status
2. Allow patients to share preferences
3. Empower patients with a sense of control
health systems can enhance trust while building patients self-efficacy. For example, Digital Whiteboards that inform a patient of their status toward discharge and what is on the daily schedule proactively lets them know how they can work toward getting back home. Additionally, allowing patients to provide their input into a hospital stay from completing a satisfaction survey, to selecting the language interface on their TV, to inputting content that can be displayed on a whiteboard or digital door sign provides a sense of being heard and participating in their care. If you want to further boost internal locus of control, allow patients to manage non-clinical aspects of admission such as ordering a meal or changing the temperature and lighting in the room. Creating a sense of control in what was an unfamiliar environment builds patient confidence in managing their health by collaborating with the care team.
These are just a few examples. Healthcare is complicated and intensely personal. By working to understand preferences and barriers to engagement, it is possible to make creative use of technology to foster “care with” collaboration that improves outcomes and experience for all stakeholders.