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What makes a high-risk patient, and how do we care for them?


With the paradigm shift to value-based care, physicians, health plans and policy makers are all striving for a crucial goal-achieving better outcomes at lower costs

Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Henry Anhalt, DO, who is in private practice treating pediatric patients with type 1 diabetes. He is also chief medical officer for T1D Exchange, a nonprofit organization. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.


Quality means different things to different people, especially as it pertains to healthcare. To those receiving care, quality can mean the amount of time their doctor gives to them during a visit or even the promptness of the visit.


Further reading: Do quality measures disillusion young doctors?


With the paradigm shift to value-based care, physicians, health plans and policy makers are all striving for a crucial goal-achieving better outcomes at lower costs. This is challenging for a typical patient. How can we help our highest-risk patients achieve the best possible outcomes at the lowest possible cost? It’s complex but there’s one answer that’s simple: use empathy.

Henry Anhalt, DO

There are a lot of factors out of our control when treating high-risk patients.

Today, we can’t cure most chronic illnesses. We can’t ensure access to or desire to live a healthy lifestyle. We can’t make our patients younger or take away compounding issues that put them at high risk. We have limited control over patients who can’t make appointments due to lack of transportation, or various family factors.

It can be difficult to treat patients whose insurance doesn’t cover specific medications. While we face plenty of limitations, there are factors we can control. Using empathy (putting yourself in the patient’s shoes) is one of the simpler – yet mostly effective - ways physicians can help high-risk patients.

Empathy is a powerful communication skill that is vitally important to the patient-physician relationship. Validating a patient’s emotions can instantly change the dynamic of the conversation and increase the efficiency and value of gathering information. 


Related: Better quality will equal better pay for physicians


The empathy we as physicians convey to our patients, their families, and to our staff creates the culture necessary to improve outcomes and patient satisfaction. However, empathizing can be difficult at times, especially when a patient doesn’t feel comfortable opening up to discuss how they are feeling. High-risk patients are especially susceptible to this – they may not want to share a prior experience that contradicts your care plan for them.

Next:  A few key steps to effective empathy


Regardless, the benefits of being empathetic can be tangible for both the patient and the physician. A few key steps to effective empathy include:

1.     Legitimizing a patient’s feelings

This is especially important when treating conditions that may not be physically visible. Legitimizing a patient’s feelings builds trust between the patient and the physician, and can ultimately lead to better outcomes, as the patient may be more willing to discuss their ailment.


In case you missed it: ACP urges collaborative action to put patients before paperwork


2.     Pausing to imagine how the patient might be feeling

Putting yourself in your patient’s position is a powerful tool and requires reflection. Take the time to truly read the patient – what is the body language, tone, and word choice? Are they angry? Tired? Defeated? Perhaps they are burned out from their medication regimen, or may be skipping medication here or there because they don’t see immediate benefit. Recognizing these feelings and legitimizing them can help patients build trust, and may increase the chance that they follow your advice and thus improve outcomes.

3.     Offer support and partnership

This is particularly important for high-risk patients. Make sure your commitment and willingness to work with them is clear.


Blog: Healthcare is only "safe" when physicians work for patients


Caring for high-risk patients is even more challenging in a value-based environment. However, by practicing empathy, you can not only can help the patient-physician relationship but also improve outcomes.  In fact, in a study of 710 cancer patients in Germany, physician empathy was positively associated with improvement in patient-reported outcomes of depression and quality of life.

 At my practice, we conducted a web-based survey  of 356 adults with type 1 diabetes on the effects of empathy and we learned that provider empathy is strongly associated with higher satisfaction among adults with type 1 diabetes, particularly.1

The transition to value-based care may feel overwhelming, but demonstrating empathy is a great first step to improving outcomes for high-risk patients.



1.      Ruck, John D., Shah, Viral N. et all. American Diabetes Association Scientific Sessions 2015. Poster Presentation “Factors Affecting Satisfaction With Providers Among Adults With Type 1 Diabetes: A Web-based Survey”

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