Alan Weil, the editor of Health Affairs, opened the Colorado Health Symposium arguing that the future of health care is greater engagement. He describes five different types of engagement including engaging the whole patient and engaging the social support of the patients. Of course implicit in this vision of the future is the critique of the present. Our experience surveying and talking with our members backs up the notion of doctors not being as engaged as they could or should be.
Many doctors wonder if the big changes in the health care delivery system will foster more engagement, and what that engagement will look like or whether the changes are creating greater alienation between doctors, patients and health care institutions. Is the traditional idea of the doctor-patient relationship as the cornerstone of medical engagement becoming antiquated? For example what does engagement with an ACO (Accountable Care Organization) look like.
In a June 16th MEDPAC Comment Letter to CMS on ACO’s, we can see the new language of patient engagement. Engagement is between an “ACO” and a “beneficiary” and it does not seem to be working:
“One source of frustration for many of the ACOs we have spoken with is their limited ability to engage with their beneficiaries. ACOs are supposed to be patient-centered, yet their avenues for communication with their patients are limited.”
From the doctors’ perspective it often feels that patients are being replaced with lists and data points. The issue is not to hold onto something that did not work in the past, but to consider what a new engagement in the future would look like.
In the Harvard Business review Dr Lee and Dr Cosgrove use the work of Max Weber to explore what motivates doctor engagement. In an interview with Becker’s Hospital Review about the article Dr Lee argues that engagement must go beyond data into the narrative of the Doctors
“Creating a shared purpose is about realizing what makes us proud or what makes us ashamed, and data can’t do that the way a story can.”
Unfortunately management often sees the problem as limited to how can we motivate our doctors, and while this is fine as far it goes, there are definite limits. As engagement changes, doctor autonomy will also change and it is hard to imagine engagement as something being passively given to doctors. Our question, as a doctors’ union, is what kind of structure and power will allow doctors both the autonomy and space to engage themselves?