‘Questions are the answer’

The consensus is virtually unanimous: If they want better care, patients need to speak up. But for many, this is easier said than done.

If three decades’ worth of research on patient engagement is any indication, most people tend to suddenly become silent in the doctor’s office. Some studies put the average number of questions asked during the appointment at only two.

How to change this?

Encouraging people to ask more questions and giving them some tools to get started with question-asking behavior is the focus of a newly launched campaign by the U.S. Agency for Healthcare Research and Quality, It’s called “Questions Are the Answer,” and it’s based on a solid body of evidence that when it comes to safe, effective health care, communication matters – not only communication by the doctor but by the patient as well.

The AHRQ campaign is the latest in a widening national effort to better equip patients to become active partners in their care.

What can happen when patients are too passive about asking questions? They could have the experience of Alastair McGregor, whose story appears on the AHRQ website in a collection of videos featuring patients and clinicians. McGregor’s heart rate was excellent but he had high blood pressure, so his doctor prescribed medication to lower it. Unfortunately the medication led to an increasingly irregular heart rhythm – which McGregor didn’t report to the doctor until he wound up in an emergency room.

Lesson learned: If there’s a problem, bring it up, McGregor tells viewers. “This is not a question of just taking my car in to have the oil changed, and sitting there while it’s being done,” he says. “This is me. I happen to be the car.”

The AHRQ campaign makes another key point: These days, good clinicians want their patients to ask questions. The health care team can’t address the patient’s concerns or provide appropriate care if the patient doesn’t speak up, the website points out.

Because it’s all too common for patients to be unsure of what to ask, the AHRQ website offers a list of 10 “starter” questions: What is this test for? When will I get the results? How do you spell the name of that drug? What are the potential side effects?

There’s a cool Question Builder tool that helps patients prepare for a doctor’s appointment by identifying and prioritizing the questions they want to ask. There also are tips for questions to ask during the appointment itself and for following up afterwards.

It would perhaps be unrealistic to think the “Questions Are the Answer” campaign will be, well, the total answer to getting more patients involved in their care. There are plenty of other reasons why patients are reluctant to speak up – feeling rushed through their appointment, not wanting to “bother” the doctor, fearful of looking stupid or having their question ignored or trivialized. Sometimes patients don’t ask because they’re afraid the answer will be something they aren’t yet ready to hear. Sometimes it comes down to health care culture and the openness (or not) of individual clinicians to listening to what their patients have to say. Language and literacy barriers are additional obstacles that aren’t easily overcome.

Instilling confidence in people that their questions are expected – welcomed, even – seems like a major first step, however.

If more proof is needed of the importance of asking questions, consider this: Studies clearly demonstrate that when there’s good communication between doctor and patient, health outcomes are generally better. Exactly how this works isn’t entirely understood, but researchers have measured greater trust, more agreement on the plan for the patient’s care, higher-quality medical decisions, increased adherence and greater shared understanding than when communication is lacking. Moreover, asking questions is considered one of the hallmarks of positive information-seeking behavior by patients.

The only truly dumb question? It’s the one the patient wants answered but fails to ask.

2 thoughts on “‘Questions are the answer’

  1. This absolutely disgusts me. My mother’s main docs are at the Mayo Clinic in Rochester, MN but she has a local one for script refills. Her primary at Mayo charges $41 per visit & she’ll sit with you as long as needed-5 min or 60, but the local one charges nearly $300 for 5 min if you’re lucky. Don’t put it all on the patients for not speaking up. I have always been a very shy person, but 6 years ago when I had to start speaking up for both my mother and grandmother, it was the Mayo doc that gave me the courage to speak up, because she’s so easy to converse with but the locals “lord” over you like you should feel privlaged to even be in the same room as them. It’s to the point that there’s a couple of docs locally that I refuse to let them even touch my mother or my grandmother before she died in 2011.

  2. I think the operative concept here is that *good* clinicians welcome and encourage patients to speak up, yes? As stated in the blog, simply telling patients they need to ask more questions is not the total answer; there also has to be an environment that fosters this.

    All things being equal, however, many patients are not accustomed to asserting themselves in the doctor’s office, even when the doctor tries to encourage it. To some extent, this seems to be a learned skill. I had to learn it myself, and I still don’t always get it right. Often people need a roadmap that gives them a place to start, and that’s what this campaign by the AHRQ is meant to do.

    I blogged quite some time ago about the “listen up” component that is the other half of the patient advocacy equation: http://bit.ly/sN6sR9

    It’s worth noting that the research on malpractice lawsuits has shown that poor physician communication is one of the leading factors in why doctors get sued after a bad outcome. So yes, the clinician’s communication skills do matter.

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