This interview is the third in a series of brief chats between CFAH president and founder, Jessie Gruman and experts—our CFAH William Ziff Fellows—who have devoted their careers to understanding and encouraging people’s engagement in their health and health care.
Molly Mettler believes that “The grail in medical shared decision-making is making it possible to combine evidence-based options with the patient’s personal preferences and values.”
Ms. Mettler is a Senior Vice President for Healthwise and in this position, she advocates for a transformation in the role of the health care consumer from a passive recipient to one who’s stronger, more active, and involved in his or her own care. She is also a CFAH William Ziff Fellows.
Gruman: What is the most significant challenge people now face in engaging in their health and care?
Mettler: Navigating the system. Or rather, navigating our non-system. We don’t make it easy for people to a) get health care, b) go through it without harm, and c) benefit from it. There’s lots of talk about patient-centered medical homes and Accountable Care Organizations, but what do those look like and how are they going to affect me, the health care consumer? I can only hope they lead to a more rational system, and one that’s easier to engage with. Patient-centeredness and patient engagement become mere buzzwords if patients’ choices and values are discounted or undermined once they’re in the system.
Gruman: In past conversations, you have noted other buzzwords that get in the way…
Mettler: “Evidence-based” has become a buzzword. On the whole, I do think it’s useful to establish an evidence base for clinical guidelines, rather than leaving it to politics, or lobbying, or those who can craft a 15-second sound bite. However, I think “evidence-based” is being overused as a modifier/adjective and that the insistence on having that particular adjective in place tends to displace the importance of patient autonomy.
Gruman: How does it do that?
Mettler: Once the patient is well-informed and understands her options, patient autonomy in treatment needs to be honored within legal and ethical limits. The grail in medical shared decision-making is making it possible to combine evidence-based options with the patient’s personal preferences and values. If a patient chooses a treatment path not supported by good evidence, then payment for that treatment becomes a judgment call with patient, doctor, payer, and the good of the whole all part of the judging.
Gruman: What is a significant point of leverage for increasing people’s engagement in their care?
Mettler: If a “significant point of leverage” means the point where an individual has to do something about his/her health and healthcare, then I think there are three significant personal events: having a baby; at the time of a critical diagnosis of serious illness; and end of life planning, if they aren’t actively denying this is needed. These are points in the life journey where health comes to the forefront and people are ready, even eager, to be engaged.
Additional Interviews with our Ziff Fellows on the challenges of patient engagement:
- Trudy Lieberman, journalist for more than 40 years and contributing editor of the Columbia Journalism Review
- Dale Shaller, Principal of Shaller Consulting Group
- Connie Davis, geriatric nurse practitioner and health care consultant
- David Sobel, Medical Director of Patient Education and Health Promotion for The Permanente Medical Group
- Kate Lorig, Professor at the Stanford University School of Medicine and Director of the Stanford Patient Education Research Center
- Shoshanna Sofaer, Robert P. Luciano Professor of Health Care Policy at the School of Public Affairs, Baruch College
- Judith Hibbard, Professor of Health Policy at University of Oregon & lead author of the Patient Activation Measure (PAM)
- Carol Alter, Director of Policy and Community Outreach and an Associate Professor in the Georgetown University Department of Psychiatry
Tags: Accountable Care Organizations, ACO, CFAH William Ziff Fellows, EBM, evidence-based medicine, patient autonomy, patient centered care, patient engagement, patient-centered medical homes, shared decision making
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