‘Patient engagement’: a pernicious, presumptive powerplay?

There is a subtle form of power-politics implied in just about every deployment of ‘patient engagement’ you’re likely to encounter that can serve to deprive the patient of authority rather than promote the autonomy of the patient.


Because inhering within any given notional interaction described as ‘patient engagement’ as it is normally used is:

1. The presumption that the engager and the engaged have become connected in some way as a consequence. The reciprocity of connection is not a given, nor should it be inferred that a ‘relationship’ has either been established in some way as a result. To speak of one’s activities as being part of a ‘patient engagement’ initiative conveys the reassuring secondary meaning of ‘something being built’, or ‘something getting done’ that is seldom borne out in fact.

You may undertake as many exercises in ‘patient engagement’ as you wish, with no expectation of them actually connecting with, appealing to, or improving outcomes for patients.

More often than not, pharmaceutical companies’ ‘patient engagement’ is still done to, not done with patients. It’s small wonder that they fail so often as a consequence.

2. The presumption that the role of engager and the engaged are the right way round, when in fact the opposite is true. The patient should be the engager; the company should be the engaged. How can genuine unmet needs be served otherwise?

It remains easy for pharmaceutical companies to enthusiastically support ‘patient engagement’ initiatives as long as they are not required to relinquish their position of dominance as engager. The pharmaceutical industry’s role is not to be the engager, but rather to be the engaged. Activities that genuinely serve the patient should never derive from a strategic plan, but rather emerge as a response to an identifiable, clearly stated unmet patient need.

This orientation is often lost within the industry in the frenzied, headlong charge from concept to deliverable, but it’s a bad habit that could be broken simply by taking more time and committing more resources to adequately researching and landscaping unmet patient needs in the disease areas each pharmaceutical company works in.

3. The presumption that patients are waiting and willing to be engaged with. There is no reason that patients should want to connect with the pharmaceutical industry in the passive role of the engaged (initiator of action: pharma) when they have unique needs that they wish to convey in the active role of engager (initiator of action: patient).

If the pharma industry aspires to receiving a generally positive response within the postmarketing digital environments it strives to participate in, this internal perspectival change needs to be affected.

Perhaps not unreasonably, this is a change that any given pharmaceutical company may find it difficult to acknowledge, accept, and respond to as it may be seen to pose a fundamental challenge to the robust, positive PR messages that it will have cultivated. The catch is that, beyond the potential lack of relevance to patients that we have identified in the second point, this is one of the self-same reasons patients are unlikely to want to respond by default to any given industry-driven ‘patient engagement’ activity that they encounter.

This is an impasse that only the industry can change.


Let’s stop talking about the industry’s role in active patient engagement, with pharma as engager and patient as the engaged.

Let’s start talking about the industry’s role in passive patient support, with patient as engager, and pharma as the engaged.

Having read the above, if you still think they’re synonyms: think again.

6 thoughts on “‘Patient engagement’: a pernicious, presumptive powerplay?

  1. So very true this explanation between engagement, promotion, and the relationship between engager and engaged! Read it twice and let the meaning of it drip into your conscience with regard to patient engagement and strategy by the industry, as well as patient engagement by health care providers and even the so called patient ‘education’ programmes, or for that matter too: the very concept of ‘health literacy’! Who’s literacy do we meam by that!
    Great post by Andrew Spong !
    ‘Patient engagement’: a pernicious, presumptive powerplay?
    There is a subtle form of power-politics implied in just about every deployment of ‘patient engagement’ you’re likely to encounter that in my opinion serves to deprive the patient of authority rath…

  2. Hi Rob. Good to hear from you, I hope we can catch up soon on Skype 🙂 Thanks for your comment, and I appreciate your support in helping us all to consider the possibility that we may currently have the idea of ‘patient engagement’ the wrong way round.

  3. Great post, Andrew!
    I have long held the view that patient engagement is a dangerous term because it’s so easy for 2 people to use it with opposite meanings. It’s not just perncious. It can easily be perverted.

    My conclusion: “in other words “engaged patients and patient engagement are the yin and yang of health care” in

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