5 Tips to Help Engage your Patients and Clients (part II)

In Part 1 of “5 Tips to Help Engage your Patients and Clients,” we discussed the following:

1. Meet them where they are at
2. Instill trust
3. Include them in all decisions
4. Establish concrete goals with clear metrics
5. Identify barriers and problem solve

In this continuing section, we are going to describe 5 additional tips to empower and help you master patient and client engagement.

1. Involve family members, the community and use them as allies

You have worked on meeting your patients and clients where they are at; you have managed to instill trust, included them in the decisions making, and you have been working towards concrete goals.  You have also identified and addressed the barriers to engagement.  One other important step is to involve the family and community members of your patients and clients.

We met Jacob’s parents before (Part 1), and they were involved in his treatment, but because of the family’s experience, engagement was a challenge. The family’s pastor was identified as important figure, and Jacob’s doctor did his best to engage the pastor, who eventually became an ally.

The coach, the teacher, the lawyer, the probation or parole officers, the friends, the grandparents, and other relatives can all become allies and strongly help in developing the partnership with the patients and clients.  Make it routine clinical practice to explain to your patients and clients the importance of community, and involve as many people as possible as you seek allies.

2. Use motivators

People rarely do things unless they have to. This is true in healthcare and especially in mental health. The good news: everyone is motivated by something, and you only need to discover what that is.  Ask your patients and clients, and those who may know them best about motivating factors. And use the concrete goals in their treatment plans as a direction reminder. This is especially important when your patients and clients get discouraged with their slow progress.

Jay is a 21-year-old male we met before (Part I), as he dealt with substance use and his sense of identity.  Jay had to deal with a slow recovery progress, because of his cravings. He also disclosed how the challenge of getting a loan to go back to college was making him increasingly frustrated and feeling helpless.  His clinician introduced the Decision Matrix to help Jay decide if he should give up or go on. This was a useful tool to be added to the treatment plan for motivation.

What motivates your patients and clients; what fears do they carry, and what would truly move them forward? The answer to these questions can be a powerful addition to your engagement toolkit.

3. Focus on the patient/client

Standards of care and evidence based practice are important, but clinical care and doing what is indicated and best for your patients and clients must always be balanced with the desire to follow guidelines.  Remember that most research studies are conducted under specific conditions, with clear criteria, which many times may fail to be the reality of the patients and clients we serve.  Further, in an imperfect world where negative trials are rarely published and many positive trials may fail replication, there is value in making your patients and clients your focus, as you collaborate with them to find what works best for them.

Shamara, an 18-year-old female, diagnosed with Schizoaffective Disorder, Bipolar type, complained that her antipsychotic medication, Geodon (Ziprasidone), was making her “manic.”  Shamara’s report was long before the now well-documented finding that Geodon could in fact induce some hypomanic symptoms.  Remember that phase IV clinical trials can go on for several years, leading to additional information and further side effects.

Focus on your patients and clients, listen to them, and do your best to balance guidelines with what your patients and clients are saying about their own bodies. After all, treatments should always be tailored. Always be ready to think “outside the box,” finding the right balance between evidence based and listening to what is actually going on.

4. Start the process early

The earlier you start, the more successful you will be at engaging your patients and clients.

Jacob’s parents expressed they were seeing Dr. Darby, because the school was pressuring them. They also explained that despite this, when Dr. Darby called two days before their first appointment, to tell them he was looking forward to meeting them, and what they could expect, this made them agreeable to giving him the benefit of the doubt. Also, David, a social worker, often brings his patients and clients to the psychiatrist, who will see them next.

This is a great habit that can help decrease anxiety, familiarize the patients and clients with the treatment team, and also helps with the engagement process.  Start as early as you can.  If you are a specialist, ask the primary clinician to make the introductions before your first scheduled appointments.  The emphasis here is to find opportunities to start the engagement process as early as possible.

5. Have an overall engagement strategy around engagement:

A strategy around engagement would include the collective nine (9) tips outlined.  In Part 1 of this engagement article we saw the following: Meeting patients and clients where they are, instilling trust, and including the patients and clients in any decisions that relate to them.  Also, it entails establishing concrete goals, identifying and resolving barriers to engagement.  In addition to these, a strategic engagement approach would include: involving the patients’ and clients’ family members and community, and using tools for motivation, and focusing on the patient and client, and starting the process early.  After the first appointment, follow up with a phone call, proceed with call reminders for each visit, and ask for feedback early enough on the type of care they think they are receiving.  Encourage the patients and clients to access their health record information through the EHR portal (Electronic Health Record), give them a voice through surveys, focus groups, and the opportunity to participate in patient and client advisory councils.

Another important aspect of an overall engagement strategy involves paying attention to your specific attitudes (as a clinician), countertransference, fatigue, or burnout. How comfortable do you feel working with patients and clients with a substance use disorder or who are involved in the justice system?  Do you believe patients and clients should be empowered towards collaborative treatment, or do you think that doctors and clinicians are the expert and know best?  You became a healthcare professional because you wanted to help people.  Helping your patients and clients is often easier, if you make the effort to engage them.

Are you ready to make engagement part of daily practice?  As stated in Part 1 of this article series, engagement is a process; it does not happen overnight, and it requires patience, flexibility, and a different mindset, a willingness to consider a strategic approach.  As a result, to be successful, you need to desire it, and to decide to make it a priority.

Thank you so much for reading.  Now, over to you:

• What have you learned from this article?
• What experience and/or wisdom could you share with me?
• What comments would you like to leave?

See you soon.

Your friend,

Mardoche Sidor, MD

Founder, President and CEO-SWEET Institute