Ask your doctor. I think most of us would agree that is good advice…at least up to the point that we find ourselves sitting half naked on an exam table in our doctor’s office. Then the doctor walks in and for some reason many of us just “clam up.”
Patient question-asking during the primary care office visit was and continues to be an “index” of patient health information seeking behavior. Since the first of such studies going back to the late 1970s, researchers have found that, except for patients who are highly involved in their own health care, most people ask their doctor few if any important health questions.
Here’s an example of what I am talking about.
At face value, one would think that being “put on a new medication” would prompt patients to ask their doctor a few questions. Why do I need this medication? What are the side effects? How should I take it? What about other medications I am taking? When can I stop taking it?
If you think that way…you would be wrong.
By way of evidence, I cite a 2008 study in which 181 patients were prescribed a new medication by their primary care physician or a cardiologist during an office visit. In total, patients initiated 199 questions or comments (1.09 per patient) based upon a coding of audio tapes of each patient visit. Table 1 shows a breakdown of the frequency of patient questions by type and duration of patient talk time (in seconds) associated with each question topic.
Of those patients that did ask questions, the focus was on the important questions – how to take the medication, side effects, and the purpose of taking the medication. The brief amount of “patient time” spent on these important topics was compensated for during physician talk time, e.g., physicians spoke for 10 seconds on the purpose of the Rx and 8.25 seconds on how to take the medication. Keep in mind that physician talk time for all physician comments related to “starting a new medication” was less than a minute for the entire visit.
These findings may seem very counter intuitive given all the reports of coming out of the Pew Research and other survey research about patients “wanting more health information.” There are after all at least 500 pages listed on Google of health websites recommending “questions to ask your doctor.” But according to many studies on the subject, what people say they want (more health information) and what they actual do (engage in question-asking behavior) can be and usually is very different.
The low level of question-asking behavior exhibited by patients in the small study cited above study is not an isolated finding. Numerous studies going back to the landmark work done by Roter et al. in the late 1970s have produced similar findings. According to Donald Cegala, PhD, Professor Emeritus of Communication and Family Medicine at Ohio State, who has written extensively on this subject, “the literature and my research experience suggests that most patients do not ask any questions, and those that do average about 2 questions (per visit). ”
So what are the factors that explain why so few patients actively engage in question-asking? Are there strategies for getting patients more engaged in addressing this interesting challenge? Stay tuned. I will be elaborating on these questions in future posts.
Sources:
Kravitz, R., Hertiage, J. et al. How much time does it take to prescribe a new medication? Patient Education & Counseling. 72 (2008) 311–319.
Roter, D. L. Patient Question Asking in Physician- Patient Interaction. Health Psychology. 1984; 3 (5) 395-409.
Cegala, D. Personal notes. 3/12/2010.
Great article. I’ve read studies that show that doctors leave out 25% of the important information they should be telling patients when prescribing a new medication.
We were never taught how to be patients, which includes what to tell and how to tell it – what questions to ask, etc.
People don’t realize how much they can positively impact and improve their appointments, care and outcomes by getting actively involved in their care.
Patients can help doctors expand their thinking and prevent premature & misdiagnoses by information given & questions asked.
The key is learning what information to collect, knowing how to use it and having it available at a moment’s notice when they can’t recall details.
This is very interesting information. Thanks for sharing it. It’s a serious reality check when you consider how much the healthcare industry is talking about and creating inititaves that focus on/rely on increased consumer empowerment. How empowered are we? How capable are we of making good decisions about our health and the health of our families if we are not asking questions or speaking up during the office visit. I’d love to know WHY patients are not asking more questions – intimidation?, feel rushed by the doc?, want to just get out of the doc’s office/already late for work?, don’t know what to ask? And once we know that, how can we create an environment (or more awareness) that facilitates dialogue.
And what do physicians have to say about this? Do physicians wish that their patients would ask more questions? engage in more of a dialogue with them?
I look forward to your future posts on this.
Personally, before starting medical school, I had no idea what types of questions to ask. If a doc told me I needed something, then I assumed he knew better than I did.
Perhaps an article on what types of questions to ask should be posted. How a patient should prepare for an office visit, and how to be more proactive with their care.
it is very impressive how, despite our cultural differences, our activity have the same problems. I work in a small city outside Buenos Aires and I’ve been wondering “why the patient quit the pills up? do the patient know that he is very sick? was my explanation clear enough? outside the office they don’t remember anything and hhe next door neighbour opinion or advise is always more reliable for them that ours. We must live with that.
I’ve been thinking that we don’t give the patient the room, the time, the opportunity, we don’t even ask them: did you understand me? do you have any question?
We shouldn’t act like “i’m-always-in- a-hurry” doctor. It is a matter of consultation time but it is also a matter of doctor’s attitude.
We have to work outside the office, we have to teach them how to be a smart patient.
Not sure how doctors are in other parts of the country, but in NW Georgia doctors don’t want to answer questions. You ask them a question (and I have literally had two tell me this), they will tell you “Make an appointment and we’ll discuss it.” I did, that’s why I’m here now. I’m not going to pay $60 per question.
Doctors should concentrate more on their patients and not their profit margin. They should not take on more patients than they can competently take care of.