When I spoke at the eHITS2014 Vancouver conference on health and technology recently, I was happy to share with the mostly-physician audience my enthusiasm for a new health care initiative called Flip The Clinic. Have you heard about it yet?
This Robert Woods Johnson Foundation project asks our health care providers to start thinking seriously “beyond the walls” about the way medicine is practiced during a doctor’s visit.
Flip The Clinic was inspired by the educational concept called Flip The Classroom as conceived by the non-profit Khan Academy.
How does this model apply to a traditional doctor’s visit? In the current model of doctor-patient communication, the doctor, like the traditional teacher, metaphorically stands at the front of the room talking to the patient about the subject being taught. But in Flip The Clinic, here’s how it would look to patients:
“Clinicians prescribe information for us to learn before the visit – so that we spend our face time asking questions, instead of wishing after the visit that we’d had more time.”
Anne Weiss, a Robert Wood Johnson Foundation senior program officer, team director, and coincidentally a breast cancer patient, explains that Flip The Clinic features many ideas for how to accomplish this significant shift, but the one that really grabs her is called “new vital signs”.
For example, Flip The Clinic addresses a pretty basic question:
“How do doctors get to the root cause of a health problem?”
The innovative yet common-sense answer:
“By gathering a new set of vital signs that consider a patient’s overall well-being.”
“The idea is that the traditional vital signs, like blood pressure and temperature, are not the only relevant information about the factors that affect our health.”
Five questions to assess these new vital signs:
Proponents of Flip The Clinic recommend that patients be asked to rate their relationship to the following categories on a 0-5 point scale (0= poor; 5= great).
- Spouse, partner, or lack of partner
If a score falls in the 0-2 range, ask the patient to briefly elaborate on their situation. Following up on a low score may reveal a health issue’s root cause, such as new financial pressures or workplace stress that may be triggering a patient’s main health complaint. The new vital signs answers should be recorded in the patient’s medical record.
Anne says she first learned about the new vital signs when she attended a Flip the Clinic design workshop last fall at the same time she was being treated for breast cancer. And although her own treatment team obviously hadn’t yet heard the terms “Flip the Clinic” or “new vital signs”, she says that’s exactly the way they already worked together:
“The white-coats walked me through tons of medical evidence, but then they asked me to assess my attitudes toward different kinds of risks.
“They asked me about how to schedule my treatments around my job. They asked my husband about how he was faring.
“There were lots of decisions to make, and in the end, while the clinical experts had information to share, the decisions were made using vital signs reported by the world’s biggest expert in me: ME!“
These new vital signs, Anne explains, can jump-start a personal conversation with patients well outside the normal scope of the doctor-patient interaction.
But more importantly, a patient’s answers can reveal to the health care team that several interconnecting health issues might have one root cause.
While the health care provider may not be able to treat the underlying problem, just the act of identifying it can drastically alter a patient’s health – and their overall well-being. And by identifying a patient’s difficulties with a boss or struggles at home, it can also humanize or de-medicalize the clinical relationship.
But how do you fit an extra question-and-answer period into an already jam-packed clinic visit?
To address this time crunch, the new vital signs can also be gathered by a nurse, assistant, or someone else on staff. Anne says:
“By spending a little extra time with the patient now, you’re decreasing their need for medical attention later on.”
This makes so much sense to me, which is why I’ve been writing about this problem (here and here, for example) long before I knew there was already a bunch of brainiacs at the Robert Woods Johnson Foundation worried about it, too!
We know, for example, that such conversations are not even taking place before discharging a patient home from hospital, as reported in a study that found 91% of patients with chronic illness do not receive a written care plan before hospital discharge.
Patients are not being asked important questions, like is there anybody at home to help provide ongoing care? Or are there others at home depending on the patient for their care? Can the patient afford to take more time off from work to adequately recuperate? Will the patient be returning to a stressful workplace? Are there financial reasons that the patient’s expensive new prescription medications might not be taken as directed? The answers to every one of these questions can seriously impact the risk of hospital re-admission.
I’ve often wondered why so few of the many, many health care providers my Heart Sisters readers describe to me (as both hospitalized patients and during office visits) neither know nor care anything about them as a whole person. Instead, they are just the 9 a.m. procedure, the 1 p.m. consult, the 3:30 diagnostic test, too often treated like merely the obstacle between medical staff and their next break. See also: An Open Letter to All Hospital Staff
For example, I recall that while being admitted during my heart attack in 2008, I overheard a nurse describing me to another E.R. staff member as “the M.I. in Bed Eight.” I was not Carolyn. I was not a frightened real person with a family or friends or a job (in that very hospital, as it happens) – I was just the myocardial infarction in Bed Eight.
What about that time crunch, and the common belief that staff simply have no time to start focusing on those five new vital signs? How much extra time would it have required (instead of chatting over my head to each other about their weekend plans or their teenagers or what Nurse A said to Doc B last night) to actually focus on the real live person lying on the gurney beneath them?
Q: Has your health care team asked you some of Flip The Clinic’s five new vital signs questions?
- More about Flip The Clinic
- Cardiac care for the whole patient – not just the heart
- Patient engagement? How about doctor engagement?
- Six rules for navigating your next doctor’s appointment
- The lost art of common courtesy in medicine