Flip the Flip
Yesterday, I enjoyed the company of some of the smartest people in healthcare. Physicians, policy wonks, community health activists, nurses, designers, journalists, entrepreneurs, technologists and a tai chi master, all gathered at the Robert Wood Johnson Foundation to begin a conversation on “flipping the clinic,” a take on the Khan Academy approach to flipping the classroom.
It just so happened that earlier that week, my son’s math teacher announced that she would be “flipping the classroom.” She explained that the boys would be learning at home through video and textbook instruction, and then practicing what they learned the next day in the classroom. This flip would give her time to work with the boys individually, as each moved through the curriculum at his own pace.
So how would we extend this metaphor to healthcare? We covered a lot of territory at RWJF, including payment reform, care delivery and the role of technology. With sticky notes flying, we inspected the state of healthcare in America, and how we might improve things by flipping them.
As a patient myself, and as a witness to my father’s experience (he passed away last November), much of what we talked about seemed to come from 40,000 feet rather than terra firma. As Theresa Brown, a clinical oncology nurse, suggested, patients are kind of busy being sick. But there were some nuggets that I could hold onto.
One was John Moore’s (Atelion Health) idea of “scaffolding the patient towards autonomy” which I think means teaching patients about their disease, how it affects their body, their treatment choices, and why they work. Self-prescribing sounded less plausible, but collaborative titration not only made sense to me but was something I did when getting off of prednisone.
I was more skeptical of a plan to train patients into experts, but that’s due to personal bias: in my experience, once healed, people abandon their patient communities and return to their normal lives. If John’s team can train and retain patient experts to counsel the newly diagnosed or chronically ill, he will have solved a very big problem indeed.
Rishi Desai’s story of a 14 year old chronic TB patient who monitored, reported, and even suggested next steps based on her liver enzyme profile was heartening. Formerly a pediatric infectious disease specialist, Rishi now works with Khan Academy to bring “open-sourced, high-quality medical and health education content to anyone, anywhere.” Rishi described a sense of great satisfaction, even joy, at empowering this young patient to participate so deeply in her own care.
Which brings me to this final and startling nugget: joy and satisfaction are apparently in short supply amongst care providers, particularly those on the front lines. So I find it curious that we focus so much attention on salvaging the wellbeing of the patient, when studies and the emerging crisis in primary care suggest that more attention needs to be given to improving the wellbeing of clinicians.
So here’s a flip that we might consider: could patients cure clinician burnout and other problems in our healthcare system? We can only find out if we invite more patients to the conversation, a flip that is long overdue.