Seven gastroenterologists share insight into the best ideas for improving patient engagement in gastroenterology.
Ask a Gastroenterologist is a weekly series of questions posed to GI physicians around the country on business and clinical issues affecting the field of gastroenterology. We invite all gastroenterologists to submit responses.
Next week's question: What was the most exciting thing you learned or experienced at Digestive Disease Week this year?
Please submit responses to Carrie Pallardy at firstname.lastname@example.org by Wednesday, May 28, at 5 p.m. CST.
Mohammed Barawi, MD, St. John Hospital & Medical Center (Detroit): It is important to listen to your patients and make them active participants in their care. By explaining their disease process in a manner they understand, patients are more likely to comply with treatment. I believe that the doctor-patient relationship is a team effort and both sides need to be active participants. It is important to have a set of goals that working as a team you can reach. By taking time to develop a plan, explain their disease and treatment options, patients know that you care and are here to help them take control of their health.
Elliot Ellis, MD, Team Lead, EMA Gastroenterology, Modernizing Medicine: Patient engagement has always been a key component when improving health outcomes and forming a good physician-to-patient relationship. It's becoming increasingly important for physicians to have a game plan on how they will increase engagement; especially with meaningful use stage 3 on the horizon. An important area to look at is the use of technology and how advances in technology can be a great way to increase patient engagement. First, the use of mobile devices and wearables can help patients track what they're eating, how the items they consume make them feel and how long it takes for this feeling to occur. This can be key to identifying a potential problem with the foods and beverages they are consuming. Additionally, mobile tracking tools can help remind patients when to take medication.
A second way is in the exam room. Physicians and patients alike complain that the use of EMR systems is a barrier to good care since many times using these systems requires the physician to turn away from the patient. Being able to look a patient in the eye during an exam is paramount. To help alleviate that, using a mobile EMR system – such as EMA Gastroenterology on the iPad – is quite helpful. I don't have to turn away from patients during the exam, plus EMA's intuitive interface and visually appealing graphics allow me to walk through processes and diagnoses with my patients in real-time. It's an effective educational tool that helps patients visualize what's going on with their health.
Larry Good, MD, FACG, founder, CEO Good Pharmaceutical Development, CEO, Compassionate Care Center of New York: Gastroenterologists can best improve patient engagement in their care by giving them part ownership of their treatment. Most gastrointestinal problems are chronic and most symptoms are provoked by certain behaviors. Making patients aware of the consequences of dietary indiscretions, avoiding trigger foods and enhancing their understanding of their condition's natural history enhance engagement. Making yourself available by traditional or electronic means also improves relationship and engagement. Calling out inconsistent or non-compliant behavior in a supportive way also helps.
In sum, shared responsibility and good communications improve patient engagement and outcomes.
Sameer Islam, MD, MBA, Southwest Gastroenterology (Lubbock, Texas): One of the best and easiest ways gastroenterologists can improve patient engagement is being involved with social media. By being active in twitter, Facebook, or writing a blog patients can know who you are (both as a physician and personally if you want), and you can send a message that is tailored to your practice. I have been active on twitter for a couple of years now (@sislamMD) and have an active blog (www.sameerislam.com); I tweet interesting articles I’ve read, information about my practice and patient conditions, and any urgent office news. I have had many patients comment on my twitter posts and blog articles and have gotten a number of new patient visits based on that. Even better, it only takes a couple of seconds to send a tweet and a couple of minutes to write a blog post, but the impact is far-reaching. I would highly encourage any gastroenterologist to be active in social media. It is an easy way to improve patient engagement.
Joann Kwah, MD, attending physician, division of gastroenterology, Montefiore Medical Center (Bronx, N.Y.): In the modern era, successful patient care means patient involvement and partnership with care providers. The successful implementation of this is an important goal for many health care systems today. Currently at Montefiore, we are at the leading edge of patient-centered care with our many opportunities for patients to meaningfully participate in their care.
One of the most important tools that we have to engage patients is our direct colonoscopy referral program. This patient-centered program allows the patient to decide to pursue a colonoscopy for a colorectal cancer screening even before meeting the gastroenterologist. This approach to CRC screening empowers the patient to make the decision with her primary care physician to pursue this test. If the patient is a good candidate for the direct referral program they are paired with a navigation team that helps them plan and prepare for the procedure. The care is designed to be patient-centered and contribute to better patient outcomes.
Additionally, Montefiore has built digital platforms to help physicians engage their patients. On our intranet is a "Patient & Community Health Education" page that offers resources that facilitate patient participation. For gastroenterology patients, we may use this webpage to find helpful literature for our patients or workshops and support groups at Montefiore that can help them manage the psychosocial aspects of chronic conditions.
Montefiore also provides an internet based online patient portal called MyMontefiore, which allows the patient to access their medical records. The platform also enables our patients to communicate with their physician via the internet which may be more comfortable for some patients and it eliminates the need for frequent office visits. Montefiore is at the forefront of the patient-engagement model and continues to work to provide excellent care.
Antonino Mannone, MD, gastroenterologist, Main Gastroenterology (Williamsville, N.Y.): I have to admit this is the era of the Internet. I have been practicing for a long time and always believed in the direct personal touch: long conversations with my patients and long explanations of symptoms and therapies and prevention.
Now, I'm a strong believer in the necessity of being present and visible on the internet. I can reach more patients at once; the answer I give to one patient may be useful to ten more. I share with my patients news and medical articles of relevance. I see my patients getting more involved in the care I give them and more adherence to the medications I prescribe.With my great surprise the new technology has also been accepted by my elder patients as much as by my young patients. Leaving in a city with "brutal" winters I can keep in contact with my patients even if there is a traveling ban. As you can read I'm totally sold to the new avenue, and I find it the best way to engage my patients.
Pankaj Vashi, MD, Lead National Medical Director, National Clinical Director of Gastroenterology/Nutrition, Metabolic Support and Gastroenterology, Cancer Treatment Centers of America at Midwestern Regional Medical Center (Zion, Ill.):
1. As we see a change in the environment of care, gastroenterology has become predominantly a procedure-focused field where physicians spend the majority of their time in the endoscopy suites where patients are sedated. Many gastroenterologists have open access scheduling for screening colonoscopies, which lends itself to minimal interaction with patients. It is important to build in meaningful face to face time with patients, including the caregivers (significant others). Patients and caregivers need to be empowered in the decision making regarding their health. We've all been there at some point in our lives. The interactions and connection we build with the people who are caring for our physical and mental health boil down to two simple elements: the care we receive and the trust we feel. Make an effort to build in that face to face time with patients, prior to any procedures, and the engagement and patient satisfaction will follow. I realize this can be challenging at times, especially when optimal reimbursement for services requires increased procedure volume, but in the long run I am confident the benefits will shine through.
2. Incorporating midlevel practitioners (NP/PA) in the practice can significantly improve patient engagement and is financially feasible in today’s health care environment.
3. Improve communication with patients by implementing the practice of a follow up phone call on the day after their office visit or procedure to check on their wellbeing and to see if they have any questions. Other simple but important things that can be done are reminders about future appointments and email/text alerts from the staff can significantly improve patient engagement. Any and all upfront and post communication is sure to greatly improve engagement.
4. This one relates directly back to my point on face to face interactions. Trust is vital to engagement. And when, as a result of our findings, there is an unfavorable pathology or radiology report, this is a defining moment to build trust. Due to the sensitivity and negative nature of this type of news, it should not be shared with the patient or caregiver by phone, email or text. One of my strategies has always been to call the patient for a follow up office visit and discuss the findings in person. This way we can also discuss the treatment options and answer any questions patients may have. This is especially true with a serious diagnosis such as inflammatory bowel disease, hepatitis or cancer.
5. The internet and social media can be both a friend and a foe. We need to help educate patients on how the internet and the use of social media can be useful in locating important details about their health issue and where they can find support from others going through a similar situation. Many of patients get incorrect information from the internet which can increase their anxiety regarding their illness. Guiding patients to the correct source for information will help us improve patient engagement. Also, many physicians are comfortable communicating with their patients through texts or emails; however, it is important to be well versed on the rules and regulations surrounding HIPAA before jumping straight into this practice. There is software available that helps you protect sensitive patient information when communicating through texts or emails.