Sep 15, 2013

The Flipped Doctor's Visit: Turning the Traditional Medical Encounter on its Head

A third of prescriptions for medications are never filled by patients. Half of all medications for chronic diseases are not used as prescribed. In addition to the resultant harm to human health, this is an immensely expensive problem, estimated to cost the U.S. health care system between $100 billion and $290 billion a year.

My colleagues and I were recently discussing the Agency for Healthcare Research and Quality's review of current evidence on what works to increase medication adherence. There were a sizable number of clinical interventions
covered in this review. A large majority of them focused on education and coaching for patients with chronic conditions, including diabetes, high cholesterol, high blood pressure, heart disease, asthma, and depression. 

However an unsettling conclusion of this review was that the majority of educational approaches are at best moderately effective in improving medication adherence, and generally poorly effective in improving patient outcomes.

Given that the median doctor-patient visit in the U.S. is only 15 minutes long, it is not surprising that we need more creative strategies to inform and educate patients. And as is the case for most innovative solutions in health care, we need to look outside clinics and hospitals.

The world of K-12 education is in a state of flux as we are rapidly realizing that our children are being taught, but are not actually learning. Innovators in education are experimenting and finding gratifying success with a "flipped classroom". 

Essentially, the part of educating that deals with passive transmission of information is being moved out of the classroom to videos that children can watch at home. And homework (the traditional kind where I pull my own hair out while trying to crack 6th grade math problems), is being moved to a more interactive classroom under the guidance of teachers. 

In this model, teachers cease to act as passive deliverers of content, and function instead as facilitators of learning. Moreover, instead of all children imbibing the same content at a fixed teacher-driven pace, they learn materials at their own pace based on their individual skill level.

So now, instead of my woefully trying to figure out least common multiples and greatest common factors, I can just have my child watch Sal Khan from the Khan Academy explain these concepts in his easy-going avuncular style.

Fast forward a handful of years. The Robert Wood Johnson Foundation has now teamed up with the Khan Academy to develop ideas on how to create a "flipped clinic". It is quite likely that the fire hose of information that patients receive at their clinic visit (of which 80% to 90% is forgotten) can be delivered in smaller and more digestible snippets before or after the visit in the form of videos, blogs or other on-line content. 

The doctor's visit is then leveraged for higher value actions that might truly benefit from an in-person visit - building trusting relationships, a physical exam, a reassuring hug, a frank conversation, a high-five at a lifestyle goal attained. 

- Ulfat Shaikh

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