What’s Next Health: Flipping the Visit

Jul 18, 2013, 3:00 PM, Posted by Pioneer Blog Team

Rishi Desai Rishi Desai, medical fellow at the Khan Academy

Each month, What’s Next Health talks with leading thinkers about the future of health and health care. Recently, we talked with Sal Khan, founder of the Khan Academy, who shared his vision for “reimagining education” and what that means for health and health care. Khan Academy medical fellow and Pioneer grantee, Rishi Desai, MD, MPH, shares thoughts on how Khan Academy's approach to learning can help transform the patient experience.

By Rishi Desai

In my pediatric clinic, I generally get 20 minutes with each patient, which is long by many standards. I spend most of that time asking questions and sharing a treatment plan, leaving only two or three minutes to really talk with people about my assessment and address their thoughts and concerns. As a result, patients (in my case, a child and their accompanying adult) too often go away unconvinced or confused about what to do next.

But what if we flipped the visit? What if I could spend time quietly listening to a patient who comes to me already informed and prepared to talk about her child's health and any issues she might be facing? What if the doctor/patient visit allowed us to build better trust—to work as partners instead of me “giving a lecture”?

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The fact is that is increasingly what we’re doing.  At Khan Academy, we help people flip the classroom by providing videos on content traditionally taught in the classroom that students can watch at home, learning at their own pace. When we apply that same model of knowledge sharing and learning to the patient experience, using video with clear, in-depth health information that people can view at home, patients and family members are better able to understand their condition, assess changes in their health, and they come to the visit better informed. And I can use our time together in the office to engage in the issues important to them.

Learning in the comfort of your own home, when you are ready to learn, makes a world of difference. Understandably, people don't always take in medical information in the office, especially after they hear “red light” words, like “cancer” or “mass,” that can make it hard to keep listening. At that point, whatever I say is probably not getting through. Instead of continuing to talk at them, wouldn’t we both be better off if I gave them a few minutes, prescribed a video to watch and asked them to call me when they’re ready to talk?

Some doctors may fear this closing of the information gap will make them less valuable. Patients have access to virtually the same information I have, so why bother to see a doctor? But I believe an informed, knowledgeable patient will see huge value in talking things through with a doctor—someone who has seen this before and can provide expert guidance, an experienced coach they can rely on in difficult times.

When patients have the tools to dig deeper outside the doctor’s office, we can have a better conversation inside of it.

I often think about my own experiences as a patient. My doctors respect and trust me. If I suggest something reasonable, they go with it. It's a good, collegial relationship and I feel informed and empowered when I leave the visit. Wouldn't it be great if all patients could feel that way? People don't need a medical degree to own their own health the way I do. A flipped visit can help us get there.

Join us as we explore the tremendous potential flipping a visit has to improve the experience for both patient and doctor.

For more on Sal Khan’s ideas and the Khan Academy’s impact on the future of health and health care, visit What’s Next Health and watch a conversation with Sal and RWJF's Mike Painter. To further explore the idea of flipping a visit, read Thomas Goetz's post on the Culture of Health blog.