Flip No. 2

Assess new vital signs

Get to the root cause of a health problem, consider a patient’s total well-being.

By Flip the Clinic

In the clinic, care providers routinely gather data about how their patient’s body is performing—monitoring blood pressure, weight, and inhales and exhales. But these outputs offer a woefully incomplete picture of all the elements that contribute to a person’s health. Sure, the numbers may help reveal a problem like high blood pressure. But beta-blockers, which are prescribed to lower blood pressure, are just a band-aid if the root cause of the patient’s hypertension remains untreated.

For 15 years, Dr. Jordan Shlain, an internist and entrepreneur based in San Francisco, has been asking his patients a set of five questions about the stresses and pressures present in their lives. He’s found immense value in starting a short personal conversation with patients outside of the normal scope of the doctor-patient interaction.

By discussing difficulties with a boss or struggles at home, “It humanizes or de-medicalises the relationship,” says Shlain.

But more importantly, a patient’s answers can reveal that several interconnecting health issues might have one root cause. While the 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 wellbeing.

How do you fit an extra question-and-answer period in an already jam-packed clinic visit? While Shlain walks through the exercise with his patients himself, the new vital signs can also be gathered by a nurse, assistant, or someone else on staff. By spending a little extra time with the patient now, you’re decreasing their need for medical attention later on.

Case Study

Consider the example of a man in his mid-60s with high blood pressure, difficulty sleeping, and a small, untreated stroke on record. He’s on blood pressure medication and blood thinners. His health is managed, but he’s still he’s not healthy. During a visit to the clinic, his health care provider asks about his relationship with his wife, to work, and sleep. All are lousy, he says. Why? His wife is having an affair, he says, which is a distraction at work and the likely source of his insomnia.

The provider responds by suggesting that the patient see an expert trained to help with the core problem, in this case a couples counselor. “If you present someone with suggestions that they’d never thought of, you open a door for them,” says Dr. Shlain. If the patient follows through, he could improve a lot more than just his marriage.

The New Vital Signs

Step 1

Ask the patient to rate their relationship to the following categories on a 0-5 point scale.

This can be done by a doctor, nurse, assistant, or someone else on staff.

Step 2

If a score falls in the 0-2 range, ask the patient to elaborate on their situation.

Following up on a low score may reveal a health issue's root cause. Ex: New financial pressures may trigger a patient's insomnia.

Step 3

Record the information in the patient's medical record.

Keeping track of how the patient is doing outside the clinic can add valuable information to clinic visits over time.

Step 4

Help a patient draw connections between their answers and their health.

The connection between a patient's overall well-being and their health is not always intuitive. Pointing out the relationship between the two can help a patient make life choices to improve both.