The feed from the satellites tethered above the northern hemisphere beamed down. I could hear the synthesized voice of my GPS chuckle as I tried to find the field for my daughter’s softball game. The location for today’s game was posted to my calendar by my wife—you will understand shorty the italicizing. The location placed us in the middle of a harvested field of corn.
I asked my daughter to Google the high school in the hope of getting us to the game before it ended. She responded telling me she found a picture of the school online.
I asked, “How does having a picture of the school help me find it?”
“Because I’ll know it when I see it.”
“Do you see it now?” I asked as I pointed to the rows of denuded corn.
“Well which way should I turn to get you to where you can see it?”
“I don’t know.”
“Do you think maybe you should have Googled the address instead of a picture?” I could see she had no understanding of why I asked the question.
I called my wife, having failed to engage my daughter, hoping to engage my wife’s help. “By any chance do you have any additional information to help me find where the game is being played?”
She checked her email, and replied, “Oh, it looks like the game was cancelled.”
“And you know this how?” I was still trying to engage her in a meaningful conversation, hoping she would give me access to the information I needed.
“I got an email at nine this morning—four hours ago.”
“Do you think this information would have been helpful to me? We have been driving over corn kernels for an hour.”
“Oh, quit whining. You are having special time with your girl.”
My desire to engage my wife in a meaningful conversation about why I did not have the information had hit a virtual Chinese wall. The empathy fairy wasn’t going to make an appearance.
When the need to engage someone fails repeatedly, people become frustrated. And when people become frustrated they become stupid. And when they become stupid they get a time-out. And when they get a time-out America’s prisons become overcrowded.
My desire for empathy, my effort to engage my wife, to have her help me solve my problem had failed. Were I less amiable, less even-tempered, had I less jocundity, I would have become frustrated and done stupid things. And I would have received a time-out, and I would have added to the problem of prison overcrowding.
Had I received a time-out and added to the problem of overcrowding our prisons, I would have been among friends. After a few months of being locked in the big-house, I would meet other husbands who had failed to engage; simple men who had become frustrated and who had received a time-out.
We would shuffle around in our prison slippers and K-Mart pajamas, and we would play pinochle in the prison’s cafeteria. Then, after a few months of planning, my group of men would have devised an escape to get back to our former lives.
Then one of us, the one who had been serving his time-out the longest, would make the point, “Look, if we break out, and return home, sooner or later something will happen that will get us sent right back here. It may be from one of us trying to engage by asking something stupid like, ‘Why do you need so many pairs of black shoes?’ It may come from a misunderstanding of how to use pronouns, like if you asked, ‘Why do you ask me can we take out the trash when what you really mean is can I take out the trash?’”
Then the other guys on the escape committee would look forlornly at each other. Then the guy who had been inside the longest, the one who had carved a hacksaw blade from a bar of Dial soap would get up, walk to the closest guard, and hand over the blade.
The guard would simply nod. For he had been a guard for many years, and he had learned to spot the groups of husbands planning their escape. And he knew that as the planned date for their escape approached, sooner or later the men would see the folly of their plan.
Then the guard would return to the guard’s locker room, as he always did, and he would drill a hole through the end of the soap hacksaw blade, and thread a string through the hole, and tie the ends. He would place the soap-on-a-rope blade in the jar that held all the other roped blades that had been made by all the disillusioned groups that had preceded this group.
Patient engagement is good. Patient disengagement causes people to get frustrated and it makes them want to carve a bar of soap. And when patients get frustrated they get stupid. And when they get stupid they take a time-out. And they take a time-out from trying to engage their health system.
After a while they may think about trying to reengage their health system. But many of them will remember how frustrating their last engagement experience was. And instead of taking another time out they will try to engage a different health system.
An important rule of patient engagement is that people do not want to work hard to engage a health system. People want to engage the system when it is convenient for them, not when it is convenient for the health system.