Gary Oftedahl: Financial planning and patient engagement?

In my last post (somewhat of a confession of my deficiencies) I raised a concern about my capacity to be an activated patient, and the implications that might have for what we’re expecting of our patient population.  It appeared to strike a chord, and I do appreciate several comments I received expressing confidence that I might be more qualified for a “mortgage” in a health care home than I credit myself for.

Perhaps I should let this lie, but I continue to contemplate the challenges we face in truly engaging patients in becoming active “tenants” of this proposed redesign.  I have that concern not only because I have my own self doubts, but also because I still see a heavily medical model domination of the architecture of this model, not considering what the patient wants or needs.

One of my partners at ICSI pointed out that we need to address what our patients need, not always what they want.  Her example (thank you, Jan) was referenced to 1901 when if asked what was needed to  improve travel, a citizen would have said “a bigger, stronger, faster horse” when in reality, they needed a new way of transportation, the automobile, to truly transform to another level of transportation.  That being said,  my concern about the “architectural drawings” used to design the health care home model is that they may not be considering the abilities or capacity of our citizens to succeed.

Using myself as an example, this was drilled home, perhaps incorrectly, but vividly, after my semiannual visit to my financial planner.  In an effort to be transparent, while I’m recognized as an intelligent, thoughtful, perhaps excellent physician, I’m not an accomplished financial wizard.  It might be better to say that I’m a “babe in the woods” with regard to the intricacies of finances.  Which is precisely why I have contracted with a financial planner to provide advice and support for my estate and retirement planning.

My planner is a great guy, and spends a lot of time going into detail about the diversity of my portfolio, attempting to identify the opportunities and challenges which we face as I near retirement (scary thought) in assuring I will be able to live independently and not in the basement of one of my children.  As he patiently highlights the options, he often asks if I understand.  Of course, wanting to appear competent, confident, and not stupid, I assure  him I’m totally with him.  We move through the potential opportunities and change which might be worthwhile in maximizing my return while minimizing my risk.  As we near the end of his “customer-focused” overview, we lay out several options which involve me taking some action, making some choices, and discuss following up in six months.

My last visit occurred three weeks ago, advice was given, action suggested, and in a totally compliant way, I’ve successfully done nothing further.  Now, that is an indictment of me, but as I reflect on the experience, I link my feelings to those many of our patients must sense on leaving our offices.  For me, I want to appear competent, confident, intelligent– human traits which are critical for taking action. However, through a convoluted mental process I’ll call “ego” I walk away often confused, and unable to articulate what exactly we discussed.

Why is this relevant?  Every time I leave his office, I turn to my wife and proclaim—“now I know exactly how my patients must feel when they leave my office.”  For indeed, isn’t the analogy an apt one in many senses?  As a physician, I “dummy down” my information in an effort to communicate on a peer level with my patients, but as Chip Heath describes in his book, Made to Stick, I’m saddled with the “curse of knowledge.”  Irrespective of how I try to channel my suggestions, while I hear the melody and the lyrics of my message, I’m lucky if my patient can make out the basic rhythm.

It’s a human trait that for us to engage in a new behavior or a lifestyle change, we need to feel confident, competent, and  capable of succeeding.  If I as a highly educated medical professional  have issues with making simple changes suggested by a financial planner, because of a lack of knowledge or confidence, how can we expect our patients to suddenly move from a stance of passivity to that of an actively engaged participant.  I realize there are those who are extremely activated, as best personified by @ePatientDave and others.  But the great majority I fear are far closer to my persona in dealing with my financial future.

So as we continue to develop the health care home model, soon to move to advanced primary care, followed closely by accountable care organizations, I see major challenges.  For us to think we understand and can address the types of changes and activities which will activate our patients can’t be done without many of them in the room planning with us.  Do you see that?  Are patients actively planning with you or are they organizing and acting without you?  Do we understand how we can assist patients in making dramatic lifestyle and behavior changes in a very threatening environment?  Does our sometimes paternalistic attitude allow us to give up the control we really have never had?

Perhaps it’s just me, but every time I turn around, I’m confronted with a personal example I can link to the challenges we’re facing in developing a health care home.  In fact, my car is making a funny noise.  I need to see a mechanic—oh, oh, here we go again.