Prototyping a Wellness-Focused Medical Visit
Part V in an exploration of wellness in healthcare
For this week’s entry, instead of speculating on the possibilities of wellness-focused medical visit, I’m going to test my hypothesis by building a prototype. Like most prototypes, this one is definitely released too early, with obvious flaws and opportunities for improvement. But as the Reid Hoffman quote goes, “if you’re not embarrassed by the first version of your product, you’ve launched too late.”
A generous friend graciously agreed to be my initial test subject. I asked them to take a pre-visit assessment in preparation for a different type of wellness visit. The assessment was sent to and completed on their mobile phone — in exactly 15 minutes (I get a record of how long it takes). Results were shared with their provider (me) instantly and were reviewed for approximately 5 minutes while preparing for live visit.
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Pre-visit Assessment: Version 1 assessment categories include social and emotional health (i.e., evaluations for stress, anxiety, mood and social isolation), physical health (i.e., evaluations for activity, diet and sleep), and financial health (i.e., challenges, goals and fulfillment).
Results:
SOCIAL AND EMOTIONAL HEALTH
Overall rating: 4 / 10
Top goal: Reduce my anxiety
Challenges: Stress, Lack of purpose, My mood (i.e., sadness), Poor attention or lack of focus
Stress rating: 4 / 10
Challenges: Me or my family’s financial situation, Job stability, News or political issues
Social rating: 6 / 10
Challenges: Finding time, Low energy, Low priority, Distance from friends and family
Breaking habits rating: 4 / 10
Challenges: Not enough time, Unpredictable daily routine, Feeling tired
PHYSICAL HEALTH
Activity rating: 5 / 10
Top goal: Increase my energy level
Challenges: Finding time, Low energy
Diet rating: 4 / 10
Top goal: Make more healthy food choices
Challenges: Time to find or prepare good food options, Eating too much sugar or carbs
Sleep rating: 3 / 10
Challenges: I feel sleepy during the day, even when I get a good night sleep, I often wake up at night and have trouble falling back to sleep
FINANCIAL HEALTH
Overall rating: 5 / 10
Top goal: Learn to budget
Challenges: Other(s) not listed above: No longer have independent income
OVERALL HEALTH
Overall rating: 4 / 10
1st goal: Emotional goal — Reduce anxiety
2nd goal: Physical goal — Increase my energy level & Make more healthy food choices
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Wellness-focused Medical Encounter: Next, I asked my generous test subject to come in for a “wellness-focused” visit. My idea was to conduct the visit focused almost exclusively on their wellness (as opposed to illness, injury or disease). Admittedly, I’m not a PCP so I have less to unlearn on a traditional primary care approach to patient interviews, but also have less practice conducting a simultaneously efficient and thorough one. I imagined an aspirational target of a 10–15 min interview equivalent to a current practitioner seeing 30+ patients daily with a panel size in the thousands. These may not be the appropriate parameters for Zeev’s wellness rebrand, but I assumed if I could accomplish the goals in the current time restrictions, more time with patients in a Parsley or One Medical-like model could only be better.
I recorded the interview in this simulation (with the subject’s permission of course) so I could revisit and review it with you all. Below are some transcribed highlights, along with my commentary and reflections.
Introduction:
Provider: “Thanks for coming in today for this wellness visit. We’re going to try to do things a bit differently than your typical doctor visit, and I’ll do my best to describe how it works before we get started. First, you’ve already completed a pre-visit assessment — which I’ve reviewed and was incredibly helpful in making our time today productive. So thank you for taking the time to do so. Did you have any reflections on the questions or topics it covered?”
Subject: “No, not really. It was pretty straight forward. Only thing was it didn’t really ask me about any health issue or medical history.”
Provider: “Well, that’s by design and a perfect segway into point #2. Our goal in this visit is to focus on your overall health and wellness… working together to figure out why you’re feeling like 4 / 10, and seeing what we can do differently to get you to a 6 in the near future. How does that sound?”
Commentary: I wanted to be specific about a near term goal. It doesn’t matter whether it’s a 5, 6 or 7, but I think it’s better to set a signal early that we need to set concrete goals and also to paint an internal picture of a better life lived.
Subject: “I’d obviously love to feel better, but it doesn’t sound that simple. I mean, I feel like that some days, but how are you really going to help me with that? I think I know what I need to do, it’s just hard to find the time.”
Commentary: I wasn’t too surprised to hear some skepticism about the approach I was testing, but it was interesting to hear that the subject thought it was all on them to ‘figure this out’. I wonder how many of us feel like it’s exclusively our own responsibility to improve our own well-being or that ‘it’s all in our heads’.
Provider: “Well, let’s talk about that in the context of point #3: Since you didn’t say you’re a 10 out of 10 — which I’d be skeptical of anyway — there’s got to be something that you’d like to improve and work on. I’d like to help you to do so, but I believe it will only be effective if a) you’re ready and willing to work on improvement and b) you want my help to do so. In general, I know most people want to improve, but when I say ready and willing to work on it, I mean that you’re open to discussing your daily actions, thoughts and emotions to find root causes and working with me to guide you to new actions and thoughts that hopefully turn into new emotions and habits. How does that sound?”
Commentary: I didn’t want to necessarily start out with this much explaining, but thought this point and distinction is key. My suspicion is that not everyone is going to be ready or capable of focusing on wellness. And if they’re not, then we might as well get that out early.
Subject: “Frankly uncomfortable and scary.”
Provider: “Say more.”
Commentary: Better interviewers may not have this problem, but I need to remind myself to give move space to the interviewee.
Subject: “Well, I’ve never really done that before. I normally do it with my own inner monologue, but I guess it might be good to talk through it with someone. It’s just uncomfortable because I feel like I’m under a microscope.”
Provider: “What about evaluating yourself makes you apprehensive?”
Subject: “I don’t know. Maybe feeling exposed or judged.”
Commentary: Not so surprising that we all have insecurities, but a bit surprising how quickly we got there in this conversation. This might be one of the biggest barriers to a wellness-focused primary care service: how do we get people to open up about topics and reflections that we’re taught to ignore just to get through the day?
Provider: “Well I can promise you no judgement. Just a partner in helping you get to eventually living your best life. But we’ll try to set reasonable goals, so let’s start by just talking about a life better than a 4 / 10. Are you game for that?”
Subject: “Sure, I guess it can’t hurt to talk about it.”
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We’ll pause there for this week. If it isn’t obvious, I believe testing hypotheses are critical. Ideation on paper is fun, but trying to make the model work almost always slaps you with the reality of how difficult the challenge is. Embedding wellness in today’s medical visits is no small task and will likely require a completely different approach than the current state. It’s not going to be easy, but it’s also even more clear to me how important this focus is. As societal challenges make us continually more stressed, sedentary and isolated, we need to actively address wellness as an essential part of our plan for health.
