Flip No. 41

Give patients “think time” post-appointment

Moments for reflection might improve patient understanding

By Laurie King

Developed at Flip the Clinic Lab: Phoenix

No matter how perfectly a clinician and patient conversation goes during an appointment, there’s often a moment right after the appointment has concluded where a patient realizes one question was forgotten or a part of a treatment plan isn’t fully understood. By the time the realization hits, the clinician is no longer available and getting back in touch takes some time.

Wouldn’t it be nice to reserve a little post-appointment space for reflection? An agreed upon slot where patients can process and have someone available to take follow up or clarification questions?

In schools, students are often asked to reflect during a journaling exercise in order to think through their lessons. What if patients were encouraged to take similar time for reflection? Patients’ thoughts and questions could be recorded directly into the electronic medical record so that the clinic could keep track of their health literacy and ongoing concerns over time. This encouraged “think time” in the clinic would also offer patients one small opportunity to check back in with their clinician should anything come up. It would require a bit of restructuring to carve out that follow up time in the clinic, but it would certainly have benefits for patient understanding, satisfaction, and ability to achieve their health goals and therapies.


  • Sharon McLain, RNC-OB

    I like this idea. I work in a hospital and not a clinic; but even in our unit, sometimes the physicians come in, present the information, and neglect to give the patient time to process it all before wanting a decision. Sometimes, patients may simply want some alone time so they can call and talk with a loved one as well. This would be a great practice for any healthcare worker!

    I also like the suggestion of keeping track of the kinds of questions that are being asked. If a pattern arises, this certainly can help guide the education points that the caregiver should be discussing with the patient and their families.

  • Nicholas Locke

    I think this idea is wonderful, especially for the clinics and areas where time is not of the essence. I work in the ER at a very busy ER and sometimes I think this might not work, however it would be very beneficial in a clinic, inpatient facility, or outpatient facility. I know that there are many times I as a nurse will take care of a patient after the Provider has already been in there and they will ask me a million questions that they forgot to ask the Provider. Most of the time I am able to answer these questions however sometimes it does not always work that way. I will say I try my best to make sure the patient leaves the ER having all their questions answered but still there are times that they do not. This allotted time for the patient post appointment would be fantastic for those patients who are intimidated to ask the Provider questions for fear of interruption or not getting the answer they want. I think that some patients culture affect how they interact with Providers also, you know the old ” I am suppose to be quiet and listen” culture vs the ” Ok I need to know these answers to ease my mind.”

  • Jennifer Thomas

    Jennifer Thomas

    • Whitney Bowman-Zatzkin

      Extremely important point, Jennifer, thanks for this.
      I know the Cerner suite for hospitals includes a way for patients to jot down notes but that’s a bit of a full tech overhaul. I wonder what the change to “physician rounds” might be to allow for this Think Time for patients and a timely follow up for Q&A with the MD/NP inside the hospital.

  • Danny Long

    Love the idea.. surgery informed consent comes to mind as the single most important signature anyone ever gives.
    How about audio/video informed consent, along with supplying the patient with the litature concerning the procedure to study, reflect on?
    The audio video of the conversation would give providers a tool to sharpen their skills in helping patients better understand, they could see their presentation, the patients response etc. The learning from a few hundred audio/videos like this could really improve P/P relations, understand risk benefit, and I am sure patient satisfaction and outcomes when the decision is truly informed on both sides.

  • Danny Long

    Oh, and the patient also gets a copy of the A/V file to study, and be sure they understand the risk benefit. This would all be part of the medical record informed consent, slick tool for all. :-)

  • Anna Saucier

    I think this is a great idea for surgical patients as well. Once a patient learns they need to have surgery from their physicians all kinds of information is swimming around in their head. A lot of information is given to them by their doctor. Once they leave they may think of questions to ask the doctor but will not usually be able to speak with him again until the day of surgery. There is a pre-operative visit but once again this is not in front of the surgeon. Once the day of surgery arrives the patient may be very nervous and anxious and forget some questions they have for the surgeon. The tool would help them to calmly process the information given to them at that first visit where surgery was mentioned and have all their questions answered before leaving. When a patient arrives for that pre-operative visit they will be much more informed and able to sign the surgical consent with much more confidence and understanding.

  • Daniel Tennison

    I really like this idea. I currently work in a cardiac cath lab where patients are routinely given sedation drugs such as versed or Fentanyl. They can have things such as stents, pacemakers, or heart attacks during the time they are receiving sedation, and these things are life-changing to them. They are then placed on a bed and taken back to recovery or their room. Things are explained to them but are soon forgotten with the sedation. Having a “think time” for the patients is a great idea. Letting them absorb what has happened and what they should do from here is something all patient’s should be allowed to do. I believe these patients should be allowed to contact or visit with the physician during their stay to discuss further their treatment options.