Blog | Wednesday, October 2, 2013

How do you like your visit flipped?

Lately I’ve seen a lot about “flipping the visit.” Presumably that means this: The doctor has been in the driver’s seat for far too long with the patient looking on bemused, confused, and bamboozled. Switch it around! Put the patient in the driver’s seat.

Except … wait. Is the patient treating the physician? Probably not. The patient is treating themselves! Lovely. So the physician …?

Right, right, we are talking shared decision making. There are two parties to the conversation.

So flipping, perhaps, is not the right way to think about it. We need to come to the visit with the mind of an interior designer. Put the couch over there and get rid of that hideous, unnecessary wall.

In this modified metaphor, who are the clients? Just the patient. She might want the doctor across the room, giving advice after a decision has been made; sitting at the table, sorting through the data with her; or perhaps down the hall, answering queries by email while she lounges at her leisure in her bathrobe, looking at open notes.

Meta-preferences, how the patient wants the visit to be organized, what level of involvement she prefers for the physician, what she wants to get out of any given visit, are more important than is commonly realized. Neat switcheroos like “flipping the visit” are convenient mnemonics for patient-centering our system, but don’t get at what individuals really want. Because that we won’t know till we actually ask them.

Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews. He is also a poet, journalist and translator in Yiddish and English. This post originally appeared at his blog.