The Executive Suite: Treating the whole person can reduce disparities and drive patient trust

For the first time in 50 years, life expectancy has dropped in the United States.The direct toll of the pandemic, as well as the delayed and avoided health care that stemmed from it, led to the largest one-year decline in life expectancy since World War II between 2020 - 2021.

As we continue to face the COVID-19 pandemic and its long-term consequences, it is more important than ever for providers to build trust with patients.The influx of medical information and misinformation throughout the pandemic resulted in fear and skepticism. As patients, families, and communities return to normal there is an underlying need to adopt healthy behaviors, limit personal risks, and be proactive in caring for our bodies and minds. Trusting relationships between patients and health care providers is the best starting point for individuals to reengage and address health gaps.

But many providers aren’t sure where to begin. This is where whole person care comes into play.

Whole person care is looking at an individual’s whole self- physical, mental, behavioral, lifestyle, familial, nutrition, rather than organs and body systems alone. Whole person care reduces disparities in care and outcomes by accounting for the unique needs, experiences, strengths, and challenges of each person. While fully embracing a whole-person care philosophy can take time, there are many steps providers can take today to bring this approach into their clinical practices.

Allow the patient to fully show up

Historically, we know that many marginalized groups feel excluded within health care and limit interactions, leading to late diagnosis and poor outcomes. Once the patient is in the office, the healthcare team must create a welcoming and safe environment.

Display visible signs committing to inclusivity for all, encourage staff to offer their pronouns when introducing themselves, and ask patients about their preferred names and pronouns.Hire a diverse staff that is representative of the population you are serving and have translation services available for those who need them. Providers can learn more about health equity from resources like the CDC.

Empower patients to open up by asking open-ended questions. This sparks more comprehensive conversations that help paint the full picture of a patient’s life.

When taking a patient history, dig deeper by asking about the patient’s daily life – who they live with, what they do for a living, how do they get to work, what a typical dinner is like, how many fruits and vegetables do they eat per day, etc. – with a goal of uncovering the factors (and stressors) that contribute to their overall health and wellbeing. You can learn more about factors effecting health equity from resources like the CDC.

Visits that feature more of an open dialogue help to minimize the perception a provider is simply “checking the boxes.” Documenting and recalling details of the patient’s lifestyle (i.e., whether they enjoy cooking or they are caring for their mother), also creates a familiar atmosphere at each visit.

Patients may also be more reluctant to divulge their whole self while filling out intake forms in the waiting room. To ensure all concerns are addressed, ask at the start of the visit if there is anything else the patient wishes to cover or if they have a particular goal for today’s visit.

Back to school

Every provider engages in Continuing Medical Education to maintain their licenses and certifications. It’s important to make the most of these sessions by taking courses that encourage growth and are a step outside of their comfort zone.

One topic I always recommend is behavioral health and how it impacts your practice. While it is more of a focus now, managing behavioral health conditions was not always included in the training many providers received during their schooling – despite roughly 30% of the population regularly experiencing symptoms of anxiety or depression.

Beyond the visit

Communication is everything.

Providers have a responsibility to maintain relationships with their patients beyond the exam room. This involves reaching out in the weeks and months following a visit. If a provider notices a patient did not schedule a follow-up or did not show up, ask, “Is there a reason you didn’t come back? How can we make you more comfortable?” Gathering feedback can be easy through surveys and can be conducted when checking out of an appointment or visit.

Another connection point can occur if a patient fails to refill their prescription. Connect with the patient, acknowledge they did not refill their prescription, and get to the bottom of why. According to the CDC, 20-30% of prescription new starts are never filled, and a KFF Tracking Poll found that 29% of all adults report not taking their medicine as prescribed due to cost. If we don’t know why a patient isn’t taking their medication, we can’t address the issue.

Let your tools do the work

Integrated tools can reduce provider workload when implementing a whole person care approach.

When a patient needs services beyond your office, have a trusted network of referrals at the ready. This approach is most effective when it is standardized and scaled with technology. Leverage your electronic health record to automatically show in-network providers high-quality and cost-effective options, and trusted sources for care.

In addition to a standard network of cardiologists, endocrinologists, and other specialists, consider expanding your referrals to include community resources targeted to needs like food, shelter, transportation, and childcare. Often, these social determinants of health have an outsized impact on patients’ health. Tools like www.findhelp.org can allow you to support patients in every aspect of their health.

Automated tracking of these referrals should be prioritized to ensure patients don’t get lost in the transition from their primary care provider to a specialist. Practices need a referral management process in place to close the loop and determine whether the patient completed the referral, and if not, why? Answering these questions builds trust with the patient and shows them that we are here for them outside of their time in the exam room.

The future of care

Building trust between a provider and patient doesn’t always happen in one visit. It can take time and effort on both sides to create a successful partnership. As providers, it’s important for us to create a positive first impression that conveys an investment in the patient.In turn, our patients will be more inclined to bring their whole selves to the appointment (and any follow-ups thereafter) and ultimately should yield healthier outcomes and an enhanced patient experience.