Patients seeking answers to their health questions online might instead find more questions. I mean that literally: Organizations and pundits have posted lists of questions that they think patients should ask doctors. As near as I can tell, they’ve done so to aid doctor-patient communication, improve health care, keep patients safe, and help patients get information that they need. Those are great goals, to be sure, but I’m not sure why anyone thinks that patients need more questions. Many people already have more questions for their doctor than they have nerve or opportunity to ask.
That doesn’t stop the Agency for Healthcare Research and Quality (AHRQ) from trumpeting, “Questions are the answer” for those who desire quality health care. “Your doctor wants your questions,” the agency’s website says. I wonder how AHRQ knows what my doctor wants.
So Many Questions, So Little Time
If questions are the answer, AHRQ offers plenty. For example, its website offers at least 9 questions for patients to ask about each medical test recommended by their doctor. Since doctors often order multiple tests, that could add up. The next patient can wait.
AHRQ also provides “Ten Important Questions to Ask Your Doctor After a Diagnosis.” Good luck fitting all 10 into an office visit: Over half of visits to physicians last 15 minutes or less, and doctors tend to dominate the talking.
Given the time constraints, paring down the questions to a manageable number seems wise. Maybe that’s why Ask Me 3, a program of the National Patient Safety Foundation, gives patients three questions to ask health-care providers. However, in a randomized trial, the program failed to increase patients’ question asking. That held true for both the short list as well as questions in general.
Other organizations have weighed in with questions, too. For instance, AARP offers women “10 essential questions to ask your physician now.” Never mind that some of the questions don’t even apply to all women of AARP age. The men’s version, “10 Questions Every Man Should Ask His Doctor,” suffers from a similar problem. Further questions come from the news media, hospitals, and advocacy groups.
Too Few Answers
These question lists might make you think that patients have been clamoring for questions to ask their doctor. I have yet to see any evidence of that. In fact, according to two experts on doctor-patient communication, patients often have questions that they would like to ask their doctor but don’t. In a 2012 focus group study, patients hesitated to question their doctor because they feared being seen as troublesome. They sought information before and after medical office visits because they assumed that doctors had too little time for all of their questions.
While many patients (but not all, as I wrote in an earlier post) want their doctors to provide more information than they do, asking more or “better” questions might not accomplish that. That’s because patients say that doctors often fail to provide the amount and kind of information that they need. Specifically, many patients want to hear more about risks and quality of life.
In a study of audio-recorded medical visits for blood cancer, doctors “broadcast” information: They droned on in monologues that lasted up to 10 minutes or more, with little change in their approach from patient to patient. They often explained how treatment had evolved over time, instead of stating the pros and cons of treatments in a way that would help patients choose among them.
Even if patients do get a question in, they might not get clear answers. Doctors often use words that patients don’t understand. They give answers of variable quality to patients’ questions and often miss cues to address patients’ concerns.
When patients have trouble getting straight answers to the questions they already have, why give them more questions? Questions are not answers. Answers are what patients need.
Photo copyright Alexander Raths/123rf.com stock photo
National Center for Health Statistics (2010). National Ambulatory Care Survey 2010 Summary Tables. http://www.cdc.gov/nchs/ahcd/web_tables.htm#2010. Accessed on 9/19/14.
Zandbelt LC, Smets EMA, Oort FJ, et al. (2007 Apr). Patient participation in the medical specialist encounter: Does physicians’ patient-centered communication matter? Patient Education and Counseling, 65(3):396-406. http://dx.doi.org/10.1016/j.pec.2006.09.011
Galliher JM, Post DM, Weiss BD, et al. (2010 Mar-Apr). Patients’ question-asking behavior during primary care visits: A report from the AAFP National Research Network. Annals of Family Medicine, 8(2):151-159. http://dx.doi.org/10.1370/afm.1055
Hall JA, Roter DL (2011). Physician-patient communication. In H. S. Friedman (Ed.), The Oxford Handbook of Health Psychology, pp. 317-346. New York: Oxford University. http://dx.doi.org/ 10.1093/oxfordhb/9780195342819.001.0001
Frosch DL, May SG, Rendle KAS, et al. (2012 May). Authoritarian physicians and patients’ fear of being labeled “difficult” among key obstacles to shared decision making. Health Affairs, 31(5):1030-1038. http://dx.doi.org/10.1377/hlthaff.2011.0576
Bensing J, Rimondini M, Visser A (2013 Mar). What patients want. Patient Education and Counseling, 90(3):287-290. http://dx.doi.org/10.1016/j.pec.2013.01.005
Nicolaije KAH, Husson O, Ezendam NPM, et al. (2012 Sep). Endometrial cancer survivors are unsatisfied with received information about diagnosis, treatment and follow-up: A study from the population-based PROFILES registry. Patient Education and Counseling, 88(3):427-435. Epub 2012 Jun 1. http://dx.doi.org/10.1016/j.pec.2012.05.002
Chhabra KR, Pollak KI, Lee SJ, et al. (2013 Dec). Physician communication styles in initial consultations for hematological cancer. Patient Education and Counseling, 93(3):573-578. Epub 2013 Sep 4. http://dx.doi.org/10.1016/j.pec.2013.08.023
Tai-Seale M, Foo PK, Stults CD (2013 Feb). Patients with mental health needs are engaged in asking questions, but physicians’ responses vary. Health Affairs, 32(2):259-267. http://dx.doi.org/10.1377/hlthaff.2012.0962
Hauptman PJ, Chibnall JT, Guild C, et al. (2013 Apr 8). Patient perceptions, physician communication, and the implantable cardioverter-defibrillator. JAMA Internal Medicine, 173(3):571-577. http://dx.doi.org/10.1001/jamainternmed.2013.3171