e-Patient Dave

Toward a New Science of Patient Engagement

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Beyond Empowerment: Patients, Paradigms, and Social Movements

It’s time to move beyond empowerment and engagement, and get to the deeper issues.

For 18 months it’s been increasingly clear that the nature of this work – at least mine – has moved beyond surviving cancer (though that’s great), beyond “Gimme my DaM data” (though that’s true). It’s time to examine the core beliefs that hold medicine back from achieving its potential – its mistaken conceptions about what patients can do and should be supported in doing.

So when Susan Carr, editor of the excellent Patient Safety & Quality Healthcare, asked last summer if we should do another piece, I proposed that we pick up where I left off in 2015 as Mayo’s Visiting Professor: let’s examine whether it’s time to formally examine “the paradigm of patient”; to rigorously ask whether establishment medicine’s conception of what “patient” means – especially what patients are capable of, and should be empowered to achieve – needs to be updated. If we get that wrong, then business and science and policy can’t possibly get it right.

The resulting interview is here – they made it their cover story! You can jump to that link, but if you have a moment, I’d like to say more about its background, and why this is important.

Problems in a paradigm are not to be taken lightly.

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Patient Engagement and Empowerment: A Culture War Begins (lecture at MITRE)

A Culture War Begins - title slideI’m starting 2016 with a series of posts that lay out “the arriving future” of health and care. Previous entries:

Technological advances are making new things possible, and our deepening conception of what medicine is about (and how best to achieve care) are changing our thinking about the nature of the work. We are truly shifting from “the doctor knows everything that needs to be known” to patients as potentially capable partners.

This is real culture change. Predictably, the establishment fights back: some people don’t believe it, some just don’t like change (especially change in their work), and some don’t like what they perceive to be a challenge to their authority.

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It’s time to adopt a good working definition of empowerment.

Source: dave.pt/worldbankempowerment1
Source: dave.pt/worldbankempowerment1

A major theme of my work last year was that it’s time to create a science of patient engagement (see blog posts) – a rigorous inquiry into what patient engagement is, what factors (parameters) increase it, which ones diminish it, develop some hypotheses that researchers can test. This was the theme of my visit to the Mayo Clinic as Visiting Professor in Internal Medicine in March and my tenure as NEHI’s Patient Engagement Fellow.

A science needs practical definitions. The Structure of Scientific Revolutions notes that until a field has an agreement on what a concept means, the practitioners in the field literally have nothing in common to talk about. I’ve seen that myself, when people talk about empowerment but the field goes nowhere.

It’s time for definitions.

Fortunately, a useful definition of empowerment exists.

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Quick year-end wrap – and winter retreat.

Christmas wreath HeatherKnitz

Through Monday, January 11 I’ll be on reduced availability, for a period of “retreat and think.” It’s not a full-bore vacation; I’ll be reading and writing (and blogging), but I won’t be responding to most emails.

I can still be reached for anything time-sensitive and I will still monitor contacts from media and potential clients, per the Contact page.

Year-end wrap:

Here’s a list of my favorites on this site from 2015.  I’ll repeat something I said in August:
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August: “retreat and think”

Cover of Structure of Scientific Revolutions 50th anniversary edition

For the month of August I’ll be mostly offline, for a period of “retreat and think.” It’s not a full-bore vacation; I can still be reached for anything time-sensitive (see my Contact page) but I’ll be less active online.

This year has already been full of change – Ginny’s knee replacements, Visiting Professor at Mayo, the first Patient Engagement Fellowship, new publications, and most of all, rethinking what “patient” means (and could mean), per the book that made paradigms famous: The Structure of Scientific Revolutions (right). Our movement is gaining traction, which means a change agent needs to rethink. This month is good for that (I’m only traveling to one event), so I’m going to dial back the dialog.

September will be amazing.

One reason to retreat now is that on August 28 the calendar flips from empty to packed.

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Proposing a science of patient engagement, #3: The role of unexplained observations

Cover of Structure of Scientific Revolutions 50th anniversary edition#3 in a series. Previous entries:

#1: Proposing a new science of patient engagement, including the four minute interview video that defines the need for the project.

#2: The stages of a scientific field: Thomas Kuhn’s framework for how a field becomes a science organized around a paradigm, and then, sometimes, realizes that “anomalies” mean the paradigm is no longer sufficient to serve the field’s needs.

The purpose of this project is to examine whether medicine needs to become more methodical – more scientific – about what we mean by patient engagement, and what factors determine how well it works.

The role of unexplained observations

Science depends on its findings being … dependable! Section 2 of Structure, “The Route to Normal Science,” begins:

In this essay, ‘normal science’ means research firmly based upon one or more past scientific achievements, achievements that some particular scientific community acknowledges for a time as supplying the foundation for its further practice.

Let’s add line breaks and boldface, to spotlight the elements of thought:
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