Reclaiming the Space Between Visits

One man sat quietly staring down while other focus group participants chatted away discussing the chronic back pain video they’d just watched.

The video was a 25 minute decision aid that discussed back pain, related issues like depression, and treatment options. It was meant to help them think about their goals and preferences. Ideally, patients would then find it easier to describe the quality and pattern of their pain. And they’d be primed and ready to have a more meaningful conversation with their clinician.

The other participants seemed at ease, even excited to talk with others who had the same lived experience. A couple of participants pointedly mentioned their families were tired of hearing about their chronic pain.

But from his blank stare and lack of comments I assumed this man (we’ll call him Rich) probably thought this was a waste of time. I knew from the introductions he was in his mid 60’s, worked at a factory, and was retiring soon. The moderator noticed he hadn’t spoken and called on him:

Rich, what do you think?

He sighed and I prepared for dismissive comments.

“I’ve had pain and felt tired and angry for years.”

His voice cracked and we realized he’d been internalizing what it meant for him and was choking back tears:

“And I can’t believe that a doctor would care about me enough to send me a video like this. And I realize now that I’m depressed. And I need to talk with my doctor. And maybe treating it could also help my back pain.”

The room was silent. Years later, I’m still unpacking it. This was not a video his doctor had produced — it was simply a video his physician would e-prescribe to him. Yet, he was amazed any physician would take the time to send it and make sure he saw it.

E-prescribing resources for patients helps inform people more efficiently. It leverages the time before and between visits to “flip the clinic” and orient and inform them. In 2002, Don Kemper and Mollie Mettler called it: information therapy — prescribing the right information, to the right patient at the right time.

And it is a great way to standardize information. It also reinforces what the healthcare team says during appointments — especially since we know people can’t remember most of what is said by time they leave, let alone a day or two later. And when information is e-prescribed through a platform, healthcare teams know if people are accessing and viewing all the information.

But there are many other benefits to this kind of asynchronous communication. It can ensure patients get clear, up-to-date information that’s appropriate for them. And when those resources are patient-centered and address their questions and concerns, they’re less likely to turn to Dr. Google.

Receiving a resource for his situation made him feel cared for. It normalized his experience. And it gave him time to process it emotionally. So, instead of either:

Walking into a visit where his physician might gingerly bring up the tricky topic of back pain and depression, only for him to be surprised by it and have to navigate that moment

Or his physician side-stepping the depression topic altogether

Rich had a chance to learn about the feedback loop of chronic pain and depression, recognize it was common, re-think his own experience, internalize and process it, and was now interested to proactively bring it up with his physician.

This would likely create a better conversation, a more holistic treatment plan, and didn’t put him or his clinician in an awkward social situation, something we often underestimate the effects of.

Asynchronous communication platforms also create a safe channel to gather people’s questions, concerns, goals, and preferences. In fact, people feel a sense of privacy and less judgement in a virtual setting. So, they’re more likely to honestly disclose things like: depression, worries about taking medication, how much they drink, abuse, mental health concerns, or food insecurity.

For Rich, this kind of private channel provides an easy way for him to tell his physician and healthcare team that after watching the video he’s had new insights about depression and wants to discuss them at his next visit. They’re now able to prepare for that conversation. They may decide they want to move his appointment up, call him to ensure he’s okay, prescribe more supportive information, or have him take a brief assessment instead of trying to fit all of those things into his next appointment.

Now that a pandemic has accelerated the adoption of virtual visits, it’s time to reclaim the active space between visits to educate, care for, and support people. Increasingly, there are free and low-cost platforms to do this.

A Call to Collaborate
Let’s also make it easier for all types of healthcare providers to find the patient education and engagement resources that are currently scattered across the web by creating a content clearinghouse. I’m working to do this. Contact me if you are a foundation, association, or content developer that creates resources for patients and would like to collaborate.

On May 27th, this will also be the topic of the Healthcare Leadership Tweetchat. Join us! #hcldr

About the author

Geri Lynn Baumblatt

Geri Lynn Baumblatt

Geri works to improve relationships, communication, understanding, efficacy, outcomes, experience and wellbeing of patients, clinicians, and family caregivers. Her work incorporates principles from health literacy, decision and behavioral science, neuroscience and organizational design. She cofounded the Difference Collaborative to help employers address the growing needs of their employees who are family caregivers so they can work, care and thrive.