Innovation Blog

Blog posts are written by Russell Kohl, MD, FAAFP. Dr. Kohl is the Chief Medical Officer at TMF Health Quality Institute. He works across the company to support quality improvement efforts, leads the Innovation Team and has served as lead physician for the Comprehensive Primary Care initiative.


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Flipping the Clinic

Jun 9 2017 - Russell Kohl, MD, FAAFP

With all the discussion about team-based care, it amazes me how frequently we leave out the most important members of the team – the patient and caregivers. We frequently talk about patient centeredness, but do we really mean it? We create intricate workflows and quality measures for what occurs in the office, representing almost 0.1 percent of our patient’s life, but largely assume the other 99.9 percent of their life is simply the intermission before the next office visit. We bemoan an approach to medicine that relies on acute care to solve chronic problems, and many of us spend our entire professional lives dedicated to optimizing that 0.1 percent of our patient’s life. We often look at the 99.9 percent of the patient’s life and consider it beyond our control – rationalizing, if I’m not there to advise them, how can I possibly expect them to do the right thing? This approach reminds me a bit of parenting, where you spend roughly 18 percent of your child’s life trying to prepare them to be successful on their own.

But what if we changed our perspective about the purpose of the 0.1 percent? Medical schools around the country are transitioning to a “flipped classroom” model of instruction, where lectures and facts are replaced with discussion and application of knowledge. Essentially, the homework becomes pre-work, in which medical students learn the facts in whatever way works best for them and then come to class ready to apply that knowledge.

Imagine what the “flipped clinic” might look like in a health care provider setting. Instead of trying to provide basic disease knowledge, we focus on applying the patient’s knowledge of themselves to change how they self-manage their health conditions when they aren’t in the clinic. The challenge is changing provider and patient behaviors persistently. Anyone who believes this can’t be done needs only to look at how frequently people check Facebook now from their smartphones, versus when it was solely a website accessed from a desktop computer. The real challenge to a flipped clinic or provider-patient behavior change, though, was best expressed by one of my professors in medical school: “The first mistake most doctors make is assuming that health is always the patient’s top priority, because it almost never is.” The patient’s real priorities lie somewhere in the 99.9 percent of their life outside of the doctor visit. If we want to be the type of doctors we aspire to, we’re going to have to start using our 0.1 percent of the patient’s life to understand and impact the 99.9 percent of their life and support those priorities.

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