Incendant – Becoming Enlightened

During more than 20 years of practicing emergency medicine, I’ve had the misfortune of telling too many people that their loved one has just died. I still remember the advice of a sage physician the first time I had to perform this miserable task. He said, “Make sure you tell the family the patient is dead,” emphasizing the use of the word “dead”. At first I didn’t understand this advice, but now having told so many people about death I’ve come to realize that using the word “dead” is critical.  It would be much easier to use softer and less dreadful words, but that can leave room for the family to be confused or misunderstand. And the most important thing at that moment is that they really understand.

Recently in medicine there’s been a huge emphasis on making sure patients understand what doctors and nurses tell them. Understanding is the critical first step in being involved or engaged in one’s care. Numerous studies have shown that the engaged patient is not only happier (i.e. improved patient satisfaction) but more importantly, healthier (i.e. cost less).  In fact the value of patient engagement is so great that some have called it “The Blockbuster Drug of the 21st Century”. While there hasn’t been a drug rep bribing me with food to use this blockbuster drug, I have figured out its value and a few ways to “administer” it on my own.

Over the years I deluded myself believing I provided great patient engagement. This delusion was in part because I was a teacher before I became a doctor. Didn’t I spend time talking to my patients and giving them that extra “30 seconds” to answer their questions?  Wasn’t housekeeping mad because I took time to draw stick figure diagrams on the bed sheets to better explain things to my patients?  And wasn’t I the doctor helping patients “clearly” understand what it meant to have a myocardial infarction?  I wasn’t getting paid extra for this stuff—I was honestly trying to teach.

It wasn’t until my hospital began doing patient satisfaction surveys that I finally realized my delusion. With real numbers I could see that my patient engagement was about as good as people’s engagement and marriage: 50% failed.  Patient satisfaction surveys haven’t exactly been warmly received by physicians. No one really wants to be graded by relative strangers, and I was no different, but seeing low scores for something I had tried to do well, made me think about how to do better.

The first step was a simple picture book; I realized that need after trying to explain “benign positional vertigo” three times in one night to three different people. Glazed over looks greeted my every effort to teach this physiologically simple problem. I finally realized that people had no idea what their “insides” look like and that a picture could easily solve that problem. I gathered simple images into a laminated picture book and carried it with me in the emergency department. “A picture speaks 1000 words” was especially applicable when teaching patients.  Showing the “insides” of things not only made it easier for the patient and me, it was also much quicker! I came to realize that for patients “seeing” meant understanding.

At work I’m often feel like a stewardess with the same repeated “fasten your seatbelts” mantras. I’ve said the same things hundreds of times before. The difference is that my patients haven’t heard it before and don’t know the seat belts I’m talking about.  So while I may become lazy in saying it again, they may be overwhelmed in hearing it for the first time. Not long after I had begun carrying my laminated picture book, I realized video would be an effective and consistent way to engage my patients—amazingly to me the airlines figured this out years before.

When I was in high school we typed on typewriters.  When I finally moved up to an electric IBM I almost cried over the built-in correcting ribbon. I thought society had reached its technological zenith. I say that to explain my delay in adding pictures to my practice and not immediately seeing the potential for video. Eventually I tried a simple point and shoot video of myself and admit it looks more like a hostage crisis than patient engagement. But I knew the potential. A properly produced video could save me from being a stewardess while actually engaging patients better and with complete information. I could then have the time to answer the individual questions.

The next phase of enlightenment came when I figured out what an “app” was and that Apple was a company not just a fruit. I began to see that there might be a more efficient and easy to use tool to help repair my broken patient engagement. Fortunately I had a technoguru friend with a film degree in LA – Joe Hunt. I also had a physician friend that wanted to improve his patients’ experiences. Together we began putting the patient engagement pieces — pictures, videos and even email — into a simple to use app. Now every clinician – the best patient educators and the not so good ones – can provide great patient engagement with a tablet and 5 minutes of training.

Personally, I am constantly appreciating the value of the understanding it can bring. When patient “Junior” had a febrile seizure the other day I tried to console mom. A febrile seizure appears so abnormal that it is a terrifying experience for a parent. I know this from personal and professional experience. Mom’s relief finally came not from me, but while watching the video. She could see what happened, hear the cause, and truly understand that Junior would be ok. And when “Mr. Jones” wanted to go home because his chest pain was gone and the EKG was normal, I only needed to show him the pictures of partially blocked coronary arteries that likely looked like his own. Suddenly he understood that his angina could be deadly dangerous, and he correctly decided to stay for further testing. Even after my patients go home, I can engage them by sending an email with links to the videos to re-emphasize and re-educate them or their relatives on their diagnosis and medications.

Admittedly I’m a slow learner. I also recognize it is difficult to teach old dogs new tricks; however, with our Incendant patient engagement app I feel like a new dog. Seeing people’s eyes open with understanding and hearing their appreciation makes me feel like I am doing this right. More importantly my patients get the benefits of better health that come from being truly engaged and understanding their care and conditions.