Patient Compliance vs Collaboration: Highlight from Patients as Partners Panel

Last week, I had the pleasure of moderating a panel entitled, "Realizing the ROI of Patients as Partners," and the moment that stuck with me was the opening post-panel question.

How can we engage non-compliant patients?

My response:

Have you asked them why they're not "compliant"?

The questioner laughed, said he knew I'd ask that question in response, and said, no. So I queried further:

And have you thought about whether the way we talk to and about patients - the healthcare system language of "compliance" - might be part of the problem?

Crickets in the room. Which is, unfortunately, par for the course in many, if not most, of the discussions about all the ways in which healthcare culture prevents progress in mass adoption of truly patient-centric care models.

If your child isn't doing well in school, do you ask them why, or do you tell them theymust be compliantwith your expectations - or else? If your spouse starts working late every night, do you ask them why - or do you tell them they must be compliant with your schedule - or else?

In our personal lives, we don't speak to each other in a language of binary "compliance". Why do we treat our patients this way? And, more importantly, why do we think our patients should respond and comply with this institutional condescension? Why aren't we in the habit of seeking to understand - and appreciate - our patients? We are incented for their "compliance" through quality measures - isn't it in our best interest to learn how best to support and engage, rather than scold, those we serve?

I understand there is no practical way to reimburse for paradigm shifts. There is no ICD-10 code for "systemic 'not my problem' syndrome", as it was eloquently described by Dr. Ted Eytan in his remembrance of hyper-activated patient Jess Jacobs. There is no CPT code allowing reimbursement for the hard work required to change our culture, at scale, from the ground up.

But I have hope that is it possible. There are individual innovators in practices and institutions, everywhere, who recognize these challenges and are striving to affect change within their sphere of influence - people like:

• Amy Edgar at Children's Integrated Center for Success
• Dr. Justin Smith at Cook Children's Hospital
• Dr. Bart Andrews at Behavioral Health Response

And there are a number of organizations working to bring patients and industry partners together to address and resolve these great divides:

• Society for Participatory Medicine
• PCORI

Seek them out. Seek to understand. Be the change you wish to see in the world. And always remember that healthcare is a human business - treat patients as people.