Patient engagement strategies beyond the exam room

Guest:

Charu Soni, MD, pediatrician and physician director of Leadership Development and Culture at Kaiser Permanente Carson Medical Offices and South Bay Medical Center

Podcast transcript

Transcript is autogenerated. Although edited for clarity, it should not be considered an exact replication of the podcast and may also be updated as needed.

Alex McDonald, MD: Hello, everyone. Welcome to today’s PermanenteDocs Chat. I’m your host, Alex McDonald. As many of you know by now, I practice family and sports medicine here in Fontana, California, as part of the Southern California Permanente Medical Group here at Kaiser Permanente. Today’s chat, we’re very excited, I’m here with Dr. Charu Soni, who is a pediatrician and director of Physician Leadership and Culture at South Bay Medical Center. Welcome, Dr. Soni.

Charu Soni, MD: Thank you so much for having me. It’s a great pleasure to share my story and to be here with you all today.

AM: Wonderful. We are looking forward to it. Today, we’re talking about patient engagement. And that can mean lots of things to lots of people, but we’re going to start with your story and your perspective, and then open it up. If you’re listening or watching this live, you have questions, please drop them in the Q&A. We’ll try to get to as many as we can. We only have about 20 minutes, we try to keep these short and high yield, so get those questions in early. I’ll try to remind you halfway through as well. So, Dr. Soni, let’s take a step back and tell us who you are and what you do.

CS: Absolutely. I’m a pediatrician, like you mentioned, at the South Bay Medical Center here in Southern California for [Southern California Permanente Medical Group]. I have been at Kaiser Permanente since 2011, straight from residency. I’m a USC Trojan for life, I went there for undergrad medical school and residency. I have been enjoying my tenure as a pediatrician and also having the opportunity for my role of director of Leadership of Development and Culture. That fancy title means I’m a champion for physician wellness. I teach leadership development classes and I work on collegiality, which means helping departments communicate with each other. I also run our pathway to partnership program, which helps new doctors navigate, so I’m really privileged to be part of that.

What is patient engagement?

AM: Great, thank you for joining us. Again, we’re talking about patient engagement today, so I want you to share a little bit about what patient engagement means to you, why it’s important, and then also how you have a unique way that you engage patients.

CS: Absolutely. Honestly, for me, patient engagement is connection. It’s that relationship with people. I think when you have that connection, it’s not only important for patient engagement, but for physician engagement as well. Because that’s a huge piece, it’s both physicians and patients, we’re a partnership together. When you have that connection and relationship, one, you build trust amongst each other, and then you get professional happiness for being at work. At the end of the day, we’re all humans and what we crave is human connection.

But how does that translate to patients? It’s patient outcomes. When you have that trust, people are going to make decisions with you rather than you telling and preaching. As a doctor, you get to have a relationship, and you make decisions together, what’s best for you, and includes and engages all aspects of what we’re trying to do as human beings, like equity, inclusion, and diversity work, wellness work. All of this work converges if you’re able to make that connection.

AM: Yeah, as a family medicine physician myself, that’s what I love best, is building those relationships over time. I take care of kids as well as parents and grandparents, often in the same family, multi-generations, and getting to know that whole family and having them get to know me as their physician but also as a person is just so much more valuable. And it’s just much more fun, rather than feeling like you’re going through a slog day in, day out. And by having that trust in that relationship, there’s clear data that patient outcomes are better. [Patients are] healthier, they utilize the ER less often, they utilize unnecessary or low-value tests less often. There’s so much data around how you connect with a person. And again, you and I both doing primary care, it’s important, but even in a situation like the emergency room or the acute care setting where you have to make very quick decisions, how physicians present themselves, how they introduce themselves, all of that builds engagement and trust, or lack thereof, very, very quickly. So, I think it’s not just in the primary care setting that we think about this patient engagement work.

CS: Absolutely. People think, oh, I have to have this longitudinal relationship with somebody in order to gain their trust. And you’re so right on that you can make that small connection, even if you’re quick, in and out, seeing a new patient, urgent care, that I’ve never met before. And it can be the smallest thing. You just got to look around a little bit. If you’re looking at a teenager and you see their phone, so many of them like drawings that they’ve made in their phone case, or a picture or you know, a family member, and you just have to ask, “Hey, tell me more about that.” Or even small things like, “Hey, I love your glittery shoes, where did you get those?”

I love [that] you talked about bringing yourself into the conversation. I know that we’re in a privileged spot in primary care, sometimes you can bring more about yourself forward. Maybe not so much in psychiatry and other specialties, but [we’re] able to [make] that connection. I have 2 daughters, they’re 5 and 9, and I’d actually just got my older one the HPV vaccine. I use [that] all the time in the exam room, saying, “Hey, I just got my daughter the HPV vaccine, I think it’s so important.” Bringing yourself and your experiences into the exam room, [it’s] so valuable.

I don’t know if you’ve ever had that experience as a kid when you would see your teacher outside of school. “You don’t live at the school? You have other identities besides just being a teacher?” I feel like that as a doctor, too, sometimes. I was once recognized at Costco, “Dr. Soni?” But it’s one of those things, if you are bringing yourself there and showing that you are a multi-dimensional human, you are more than just a physician, that helps with that connection piece as well.

Patient engagement strategies

AM: I remember very clearly as a resident that moment where I was like, oh, I don’t have to be this Norman Rockwell-perfect image of a physician, what society says is a physician. I can just be Alex, who’s kind of a goofball, and I can still engage with my patients, and it made medicine so much more fun, and I felt like I could just be myself, and I didn’t have to hide behind a mask, so to speak. That’s my own personal experience. Well, tell me, what are some ways that you and your colleagues engage your patients, not just inside, but also outside the exam room?

CS: Absolutely. I think that you need to start in the exam room so that it happens outside. One of the things I do is in KP HealthConnect, our electronic medical record, there’s a sticky note. I always write something in there, a fun fact about my patient like, they have a new dog. So, the next time I see them, [I say] “Hey, how’s your new dog?” “Wow, you have such a good memory!” But I also engage them and say, “Hey, I thought that was an important thing to remember, so I put it in your chart.” I show them the computer and how I want to connect with them. If I know that there was a big milestone or something like grades, [I’ll say] “Hey, we talked about bringing up your grades, and you’re getting a tutor. How’s your grades?” When you do that, the biggest thing is for them to remember you outside of the exam room. And that’s how you start getting that engagement outside.

I remember growing up I never thought of my pediatrician until I had something wrong with me, “I need to go see the doctor.” But when you’re able to engage [patients] inside your exam room, they start thinking about you outside. I actually have a recent example. One of my patients was really excited about their Halloween costume. So, I said, “Hey, when you and your brother are in full regalia in your costume, send me a picture on kp.org, I want to see your picture.” And sure enough, they sent me a picture, and it was the best. It was so fun because I created that connection with them, that excitement. And they were able to engage with me again outside of the exam room through a kp.org message which was really cool. And it’s a great kp.org message to receive as a physician, to actually put a positive spin on the big work we have on messages. But to have that little sparkle embedded in your in-basket can sometimes just totally change your mood.

AM: You know, 90% of my messages from patients are usually “I need help,” or “I’m feeling bad.” But every once in a while, you get, “Hey, thank you so much,” or “Hey, I lost 25 pounds in the last 6 months.” Those little moments, we want to hear those positive stories, too, because as you said, people think of and send us messages usually when there’s something wrong. Sending something positive can be very valuable, I completely agree with that.

What are some factors that you look for when you’re thinking about patient engagement outside the exam room? Is there something specific that you do, or your colleagues do, or your clinic does, to reach out to patients beyond the exam room?

CS: There’s a few things that I’ve seen my colleagues do when I’m covering somebody’s in-basket. They’ll send a little reminder to themselves, 3 months or 6 months out, to say call this patient back to ask about x, y, or z. So, I think it can be bidirectional. It’s you asking them to engage and tell us, “Hey, show me your Halloween picture,” or “Tell me how it’s going with your weight loss, because I know you were really excited about that new program.”

But it can be coming from us, too. “Hey, we talked about this new medication, tell me, how’s it going?” Us engaging with them and also bringing a little nudge, a little reminder. As humans, we can be that person who provides it. But I love that. I see those kinds of things in my colleagues’ in-baskets as well as things that I do.

Efficient ways to connect with patients

AM: Yeah, absolutely. There’s a great question in the chat here: seeing so many patients in clinic, any tips on how to conduct efficient engagement where you can make that connection, but still not run behind schedule and clinic, which we all we all suffer from?

CS: That’s a phenomenal question that I have like a 30-point answer to! A quick thing is just as soon as you walk in the door say “Hello!” and shake people’s hands. During COVID we stayed away from the physical contact, but it was something that I [do] to say, “Hey, I see you that you’re here,” grandma, mom, auntie. And then also high-5 the patient, you have to acknowledge that they’re there, too. So that’s a quick connection point. You don’t have to say anything, just that acknowledgement.

And then, I have to thank Mrs. Miller, my eighth grade typing teacher. I’m able to type without looking at the keyboard, I [can] ask questions and make eye contact. [Also] HealthConnect Essentials, improving your efficiency as a physician, is a huge deal. If you are able to improve your skills so that after each patient [you] finish [your] note before [going] into the next one, there’s so many factors to that. I understand that it can be overwhelming when you’re seeing a ton of patients, but these little things help.

Also, it makes you want to go to work, and it brings fulfillment. Those are the things that I think are so important. Going back to the beginning of our conversation, we can go through the grind of going through all those patients. But if you can make that interaction meaningful for yourself too, that’s the secret sauce of a career, of being able to retire at Kaiser Permanente, rather than any facility you work at, any profession, to be honest, is making that meaningful connection at work for yourself, whatever your interest is. Bringing that meaning is what creates sustainability for all of us.

AM: One quick way that I engage patients, particularly if I’m working urgent care or I’m seeing a patient for one of my colleagues, is I’ll say, “I see Dr. Mahmood is your primary care doctor. I’m sorry you’re stuck with me today, but how can I help you?” It’s a little bit of a funny joke and it breaks that ice. I can visibly see patients relax a little bit when I take time to say “Okay, you normally see this doctor I understand you have a relationship with, but I’m here, what can I do?” And I think that it works well for me, and it just takes a moment, honestly, to do that.

CS: Sometimes I’ll see patients who are from another medical center, but I went to residency with [their doctor and I’ll say], “Oh, you have Dr. Singh, I went to residency with her, she’s awesome.” [By] bringing other people up, people will bring you up, “Oh, I saw Dr. Soni, she said she loves you and she says hello!” That’s another way to engage people, is [by] bringing them up and sending messages through your patients.

Engaging patients using secure messaging

AM: Another question, do patients know that they can communicate through kp.org and use messaging on that level? I know teenagers have “the black hole” where they’re limited in how they can communicate through kp.org, but particularly for parents, younger children, and for myself and my adults, I’m always reminding [them they] can use kp.org to reach out to me. [If] appointments are hard to find, email me and I’ll try and do what I can through email. Is there something specific you do to help make sure patients know they can engage on different levels?

CS: Absolutely. I have the ability to sign people up [on kp.org] myself. It’s a big priority for me, for my patients to be able to engage on kp.org. [I’ll ask mom and dad if they’re] signed up for Kp.org. If they’re not, unfortunately it’s harder for me to sign up the child, but if they are then I can sign up the child and link their profile. [Then I can say] “okay, send me a message with a picture.” These are things that take an extra 2 minutes but saves me and the parent so much time if they’re able to send me a message [on kp.org] rather than through the call center. It decreases that barrier and access to care. We also do it at our newborn nursery; one of the tasks at South Bay for the clerk is to sign up all our patients for kp.org as soon as they’re born.

Building patient trust

AM: That’s wonderful. When I have a visit for 2 or 4-week newborns, I always [ask] mom or dad if they’ve signed [the baby] up through kp.org so [they] can email me through their chart. I have a lot of families I take care of, so often the mom will email me through the mom’s chart about baby. I [tell them] no, you have to email me about the baby through baby’s chart. Education goes a long way.

Here’s a really interesting question in the chat: Do you agree that that patient engagement and building trust is essential for timely and accurate diagnoses?

CS: 1,000%. That’s a phenomenal question. It’s about also reading the room, right? If I’m trying to convince a parent [their] child at this age doesn’t have sinuses, so they can’t have a sinus infection, I think it’s just another viral infection. If you’re able to read the room, and they are not buying what I’m saying, you [can] take that one step [and ask], “What are you worried about? What’s concerning you?” Then they’ll reveal so much to you, like “My sister died of leukemia, and this was the first sign that they had.”

If you’re able to get that piece of information, I’ve just probably saved 3 more visits. And that’s the huge part of making that connection, just reading the room and saying, is what I’m saying landing?

AM: I had a very similar experience. I had a patient who had seen other doctors multiple [times] for headaches. I sat down and I [asked], “Look you’ve been seen 4 times in the last month for these headaches, what’s going on, why are you worried?” Turns out his father had died from a brain tumor. Once you have that piece of information the whole conversation changes. I think a lot of times patients are afraid to share that more personal information, and as physicians, we’re busy, we’re trying to get through our days, we have our checklist of XY and Z we have to get through, and we sometimes forget that there’s a person attached to that checklist.

Again, that’s where that connection becomes so helpful because I see you as a person, you see me as a person.

There is a question here about engaging patients who struggle with mental health. Do you have any specific strategies or alternatives when it comes to patients who [may have a] harder time opening up or whose mental health issues are severely impacting their care?

A personal approach to engaging patients with mental health

CS: Absolutely. I think there’s a little bit of a longitudinal approach you have [take] to building that trust. I think sometimes it does take a little bit longer with those patients, and you might not be able to do it in urgent care when you’re meeting for the first time. But maybe having that relationship over time as a primary care physician can absolutely help.

If I can share a personal story, [during COVID] I developed a lot of anxiety, and I started seeing a therapist. And it was so helpful, being able to share that part of myself by saying, “You know, this is what happened to me. I went to go see a therapist, and it was so helpful for me. And maybe you might want to consider doing that, too.”

And I’m able to, once I’ve built that trust, have that relationship to say you may want to think about [seeing a therapist], too. And I’m just leaving it here as an option, I’m giving you the phone number, you can make that move if you want to. Know that it really helped me, and it really helped my family, how I show up as a doctor, as a mom, as a wife. [It’s about] giving them that permission.

AM: Yeah, that’s such a great example. Sometimes patients aren’t ready to take that step, but if you can at least give them the options and give them the tools so that when they’re ready, they can make that phone call or make that appointment. That’s a really helpful tip.

Another question: Where can physicians learn more about how they can engage patients in a way or a style that fits their practice, their setting, their style? Are there any tools or resources out there where physicians can learn how to better engage patients?

First step to patient engagement: Look inward first

CS: My philosophy is that you’ve got to look at yourself, inward first. Take half a day [to] see what’s important to you. What are your values, what is fulfilling for you? And if you can really get laser focus on what that is for you, you can totally apply it everywhere, including work. If it’s “I really love running,” [you can say], “Hey, I really love your running shoes, where’d you get those from? I like to run marathons.” You’ve got to figure out what’s your value and what’s engaging and interesting to you. I think a lot of it is looking at oneself, putting up the mirror and figuring out what’s important to you, and that’s the way you’re able to engage.

And then [there’s] also asking colleagues for tips and tricks. Our colleagues are a plethora of information, and it doesn’t have to be other physicians, it can be the nurse. The nurse is so engaging with kids and patients, and they [can be your] secret to all of the engagement, because they can tell you things that you need to know about. “You know, [the patient] had a really bad day,” or “Hey, the grandma of that family just died, so you need to know about that.” Using all of the things around you is so helpful.

AM: Yeah, that makes perfect sense. I’ve subtly asked you multiple times, so I’m just going to come out [directly]. Speaking of self-reflection, tell us about your Bollywood dancing superpower.

CS: I was a competitive dancer in college. I did Bhangra, and I did Bollywood and Garba. So, a lot of forms of dancing, and I’ve always loved to dance. When I came to Kaiser Permanente, my chief found out that I did this, and at our holiday party asked me to lead a Bollywood dance. I engaged everybody at the holiday party, and we were all dancing Bhangra. That was my second year here. After that it grew into workouts at lunchtime at my medical office building and I started doing Thursday Bollywood Breakout sessions. Dr. Harini Reddy, who helped spearhead the Women in Medicine Symposium, found out about it and she asked me to do the Bollywood Breakout session. So now at the Women in Medicine Symposium I will do a Bollywood breakout session every year. It’s something that really brings me joy, and honestly, it was one of those moments where all of my worlds collided. And it’s a really cool thing that I get to share, that I got to be my identity as a physician, as an Indian person, and as a dancer, and it’s such a fun thing for me to do.

AM: That’s phenomenal. And, by the way, shout out for the Kaiser Permanente Women in Medicine Conference. It’s not just for women, I go every year with my wife, who’s also a physician, and it’s been a great tool for me to learn how I can be a better ally for my female colleagues, both physicians and NPs and nurses, you name it, so shout out to the Women in Medicine Conference happening, I think, in June.

Well, this is phenomenal. We could go on and on, but we want to keep these short and high yield.  My last, and perhaps most important question, what makes you most proud to be a Permanente physician?

CS: Do you have another 2 hours? No, it’s that I get to be a physician and practice ethical medicine, and also that I get to pursue other avenues of my strengths. I don’t have to just be a physician. I get to do all of these other things in my director role. I am just thrilled to be a part of this organization.

AM: Amazing, amazing. Thank you so much for joining us, Dr. Soni, and sharing your expertise and your thoughts with us today. We really appreciate it.