Flip No. 27

Demonstrate a shared investment in the health and health goals of each patient

Prepare proactively for each patient’s visit.

By Flip the Clinic

This flip is one that surfaced during our research—and it seems worth exploring—but we haven’t gotten much further than the big idea. We’re putting it here as an early test. We’d love your feedback. What might we consider when thinking about this flip? Who is already exploring this idea? What is a new and creative approach to this problem? Let us know in the comments section. If there’s enough to develop the idea, we’ll give it the full flip treatment.


  • Sherry Reynolds

    Doctors often now have an EHR and in addition to a health risk assessment it would be easy to send out an email in advance with simple format that asked the patient 1) why they are coming in 2) what the background is to the problem 3) what is important to them in terms of desired outcomes

    This could follow a format similar to one that staff in NHS hospitals often use when calling another clinician for a consult SBAR (situation, background, assessment, recommendation) and would position the patient as a key member of their own care team by having the patient learn how to fill out the first two and adding in a new section (what is important to the patient)

  • Vic Strecher

    A good investment advisor often begins by learning three things: (1) what the client values (e.g., wealth, their family, their community, music), (2) how the client lives their life (Ned Flanders, Mick Jagger), and (3) the client’s risk tolerance (Perry Paranoid, Sam Sensible, Keith Richards). This information forms the basis of an investment portfolio. The clinic might serve patients better if it understood these three things as the foundation for a “care portfolio.”

  • Susannah Fox

    I want to capture a bit of a Twitter conversation that just happened since tweets are so ephemeral but are an indication of people’s snap judgments and reactions. I tweeted a link to another “flip” — the one which asks, “How can I encourage patients to learn more about their conditions?”

    One person immediately replied, “How can I encourage my doctors to learn more about my conditions?”

    And I was able to quickly find THIS flip and post the link. Hopefully they’ll join us here in the comments!

    • http://onegrenouille.wordpress.com/ onegrenouille

      As the patient who replied, I can certainly say that some of my providers have done this, including interestingly, some but not all ER staff.

      One specialist learned about my disorder well before I met him and had already looked up the diagnosis in multiple journals. Other MDs I have seen have clearly gone through and written down patient diagnoses beforehand and while they have not researched them, have at least asked about them. I am truly thankful for these MDs.

      On the other hand, my PCP does not know about my main disorders and does not seem to want to learn. Her idea is that my care should be provided by specialists. Unfortunately with an autonomic disorder as well as another underlying disorder, it should be that all of my specialists work together to understand the problem – or at least know what all of my diagnoses are. Yet so many of them see themselves as isolated entities and while they see diagnoses listed, don’t know or ask what they are.

      You might ask why I stay with that PCP – I stay with her because she’s at the hospital where I have the two providers that DO really do this; I want to keep all of my EHR in one place; she’s not terrible like some; and she updates my EHR frequently based upon my requests (eg allergies, outside MDs, etc) – even though I don’t go in to see her.

      How does a patient get her MD’s to flip the clinic when the MDs a) have so many patients and b) may not truly understand the value in doing so?

      • Susannah Fox

        Thank you!! This is a fantastic addition. Some patients are more ready than their clinicians are for this transformation. I’d love to explore this further.

        • http://onegrenouille.wordpress.com/ onegrenouille

          Thank you. As suggested by many folks in this conversation – I do contact one of my key physicians before visits and provide a list of issues. This helps guide visits very nicely.
          I also provide resources for other MDs if related to their specialty and I think they might be amenable. (But then again, I often wonder, why should I have to – they could just use google…)

  • WendySueSwanson MD

    Preparing for visit demands accurate scheduling (ideally manual entry by the patient and/or family themselves) and a place/space to describe exactly what you want out of the visit. So often (with centralized scheduling) the rationale or reason for the visit gets lost or mistranslated making adequate preparation a challenge. Often with teens (or even nervous parents) the real reason for the visit can be masked (ie they schedule under one complaint “ear pain” but really want to talk about a behavioral problem, too).
    How scheduling is improved varies widely btwn primary and specialty care but getting online and accessible templates to write-in your own agenda (as patient) will make a HUGE difference for we clinicians in preparing and sharing the agenda for the visit prior to it even beginning! I know there are some online solutions out there but not yet entirely widespread and patient-family centric. Often too many layers and people in between patient/family and clinician for transparent, clear communication.