Sometimes we know things intrinsically; we do not need someone to spell it out for us. That said, the message on sign on the wall of the reptile house at the Philadelphia Zoo was “More than fifty percent of the people killed from snake bites are males below the age of 30 who tried to handle a snake.”

Sometimes something gets stuck in my head and the only way to get it unstuck is to get the idea stuck in someone else’s head.  A few weeks ago I came across something on television having to do with a Canadian paleontologist sitting on a pebbled beach in Quebec.  He came across as the type of individual whose interest in science may have come from his belief that perhaps the Flintstones television show was really a documentary.

The paleontologist work revolved around discovering the place where fish first walked from the sea—the very fact that he was interested in finding out where they first walked seems to imply that they (fish) have walked on more than one occasion.

I know some of you are thinking, ‘And your point in writing to us about this is…”.

The television spot went on with the fellow concluding that the interesting thing is not that fish walked—which I would have found sufficiently interesting—epochs later; yada yada yada—but that without them having walked none of us would be here.  It was alchemy in paleontology and the television reporter, a willing dupe, was his Rapunzel.

What troubles me about this is that he and his amanuensis, the reporter, with her eyes wide shut, somehow managed to create a dialogue around this notion as though it (the meaning of life) actually happened the way this fellow said it did.  Her interview was like watching two left-handed men learning to dance backward without either one knowing the woman’s part.

The voices in my head started screaming epitaphs at me.  The paleontologist’s mind tacked intuitively and lurched from idea to idea untouched by the clammy hand of logic.  His premise made as much sense to me as having an oboe player in a punk rock band, yet the erstwhile reporter, with her sang-froid composure, uttered nothing more than ‘uh-huh’. It looked as though she was watching time bend as he explained the wonders of the universe to her with his do-re-mi recitation of the facts.

Some people in front of a camera have the innate ability to insult our intelligence with boredom and futility.  To me his perfervid idea seemed stranded on the edge of reality and worked about as well as a poorly used preposition at the end of a sentence.  The reporter listened and nodded and stared into the looking glass.  She never questioned whether the compass of the fish-walker’s intellectual qualifications may have been missing its needle.

Therein lays the rub.  Simply saying something aphoristically on television does not make it true.  What was intended as an ephemeral interview now exists for the folly of all of us.  The man is guilty of sharing his ideas without having a hall pass to do so, but then again, we have all done that at one point or another.

Sometimes our confusion comes from a lack of specificity about the topic being discussed. I think patient access and patient engagement could be one of those topics.  I think part of the confusion is that the two terms, patient access and patient engagement, have meanings that differ depending on the makeup of the people having the discussion.

Most people think of patient access in terms of people having access to healthcare, in terms of healthcare being available to them.  Likewise, people often think of patient engagement as engaging patients while they are being treated.

I look at healthcare as having two facets—the healthcare business (the services provided), and the business of healthcare (running the business). Looked at a slightly different way, people need two things of their provider; they need to get better, and they need to be able to do business with their provider.

Access and engagement each play a role within both facets.  As a patient I need access to healthcare—my doctor, a clinic, a hospital, but I also need to be able to access my provider in order to perform certain business processes.  Those processes include things like registration, scheduling, authorization, insurance verification, admissions, billing and collections, and disputes and claims. 

In most hospitals that type of access is limited to using the telephone or in having to enter the hospital to complete one or more of those processes. Efficient? No. Effective? Not very likely. If a person has more than one need, they either have to meet with multiple people in multiple departments. Or, they have to speak to multiple people on the phone, being placed on hold, having their call transferred, and having to call back more than once.

In most hospitals access and engagement are on a one-way path, from the hospital to the patient. Hospitals use CRM systems as a business development and marketing tool; the hospital calls the patient.  EHR, set up by the hospital, allows patients to read about themselves.  The hospital’s website allows people to read about the hospital.

These tools do not enable access and they do not facilitate engagement.

They should.

Creating two-way access would benefit the hospital five ways:

• Increased retention
• Increased referrals
• Decrease back office support costs
• Reduce readmissions
• Improve population health management

So, where does that leave us with the guy looking for the walking fish? Maybe that is how mermaids came to be.