5 Critical Questions to Ask Every Patient

When your medical practice has a new patient, starting off on the right foot can make a positive difference over the short and long term. Information you collect at the beginning of the patient relationship helps both parties avoid surprises and ensure that medical billing is accurate.

Collecting basic medical history data up front lets clinicians know if there are chronic conditions that need to be addressed, and collecting payment and insurance information lets your claims and billing personnel work efficiently so the revenue cycle doesn’t needlessly slow down. When you have outstanding electronic health record (EHR) software orchestrating the collection and storage of patient information, all these tasks are easier for your staff. Here are 5 questions every medical practice should ask when a new patient arrives.

1. What Are Your Medical and Surgical Histories?

The patient health record will be more complete and valuable if you know whether he or she has ever been hospitalized, treated for a chronic condition, had medical tests, or had surgery. Even if an adult patient had surgery or some other treatment as a child, it’s important to know about it when creating a treatment plan and delivering healthcare.

2. What Prescription and Non-Prescription Medications Do You Take?

Some people think that over-the-counter medications don’t count, or that herbal supplements don’t matter. Make it clear to new patients that the physician needs to know not only about any prescription medications he or she takes, but also over-the-counter medications, vitamins, and herbal supplements.

It’s ideal if the patient brings prescription bottles to the appointment so the information collected is as accurate as possible.

3. What Allergies Do You Have?

In addition to knowing whether a new patient has seasonal or food allergies, doctors need to know if they have any drug allergies, a latex allergy, or a serious reaction to bee stings, for example. EHRs are terrific for using this information to alert doctors and nurses of potential drug interactions and allergies so allergens can be avoided.

4. What Is Your Smoking, Alcohol, and Illicit Drug Use History?

If you make it clear up front that you take patient confidentiality seriously and protect their information at all times, they’re more likely to be forthright about whether they use tobacco products, drink alcohol regularly, or use (or have used) illicit substances. Answers to these questions can make a difference when it comes to diagnosing and treating health conditions, and reassuring patients of their privacy helps elicit honesty from the start.

5. Have You Served in the Armed Forces?

It’s important to know if a new patient has served in the military, particularly if he or she participated in one or more combat tours. This can help you learn more about physical trauma, potential exposure to toxins, and possible mental health issues like post-traumatic stress disorder, so that diagnosis and treatment options can be tailored to the patient’s needs.

Choosing an EHR Software

If your EHR system harmonizes well with your work processes, it can make things easier on your staff and ultimately on patients as well. Choosing an EHR software can be difficult for medical practices. When making the decision, a practice should consider if the EHR will help with collecting patient information before the patient enters the waiting room. An EHR is more than a software to hold patient data. A top EHR solution will help your practice achieve more accurate medical billing, improve patient engagement and communication, and share patient information with other providers.

Optimizing care requires up-to-date, accurate patient information, and efficient medical billing also depends on complete and accurate data. When your EHR system is a unified platform, claims can be submitted more quickly, be less likely to be rejected because of mistakes, and patient billing can be done expediently.

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Questions to Ask Your Doctor

We encourage you to be fully informed about your health. Below, find suggested questions to ask your doctor. They may or may not relate to you, depending upon the disease or condition.

About Your Symptoms or Diagnosis

• What is the disease or condition?
• How serious is my disease or condition and how will it affect my home and work life?
• What is the short-term and long-term prognosis for my disease or condition?
• What caused the disease or condition?
• Is there more than one disease or condition that could be causing my symptoms?
• Should I be tested for a certain disease or condition?
• What symptoms should I watch for?
• How can I be tested for a disease or condition, and what will these tests tell me?
• What tests will be involved in diagnosing my disease or condition?
• How safe and accurate are the tests?
• When will I know the test’s results?
• Will I need more medical tests?
• Do I need a follow-up visit and if so, when?
• Do I need to take precautions to avoid infecting others?
• How is the disease or condition treated?

About Your Treatment

• What are my treatment options?
• How long will the treatment take?
• What is the cost of the treatment?
• Which treatment is most common for my disease or condition?
• Is there a generic form of my treatment and is it as effective?
• What side effects can I expect?
• What risks and benefits are associated with the treatment?
• What would happen if I didn’t have any treatment?
• What would happen if I delay my treatment?
• Is there anything I should avoid during treatment
• What should I do if I have side effects?
• How will I know if the medication is working?
• What would I do if I miss a dose of medication?
• Will my job or lifestyle be affected?
• What is my short-term and long-term prognosis?

If You Need Surgery

• Why do I need surgery?
• What surgical procedure are you recommending?
• Is there more than one way of performing this surgery?
• Are there alternatives to surgery?
• How much will surgery cost?
• What are the benefits of having surgery?
• What are the risks of having surgery?
• What if I don’t have this surgery?
• Where can I get a second opinion?
• What kind of anesthesia will I need?
• How long will it take me to recover?
• What are your qualifications?
• How much experience do you have performing this surgery?
• How long will I be in the hospital?

*Sources: Agency for Healthcare Research and Quality: healthgrades. com

Health & Safety Tips

How Patients Can Take an Active Role in Their Care and Safety
Participating in your own care has many advantages.Your doctor, nurse and other healthcare providers welcome your involvement. Below, find tips for you and your family to help us ensure your health and safety:

Tip #1: Be involved in your healthcare.
To be involved in your healthcare:

Tip #2: Speak up if you have any questions or concerns.
You have a right to question anyone who is involved with your care. To be sure you have all the information you need, it can help to write down questions to ask for the next time you visit the doctor.

Tip #3: Identify yourself.
Be sure the healthcare professional asks your name and birthdate. Also, don’t hesitate to inform the healthcare professional if you think he or she has confused you with another person.

Tip #4: Ask healthcare workers tell you what they plan to do before you consent to any procedure.
Healthcare workers should tell you what they plan to do before any procedure. Also, you can remind healthcare workers who have direct contact to wash their hands. Handwashing is an important way to prevent the spread of infection.

Tip #5: Bring your doctor a list of your medications and mention any allergies you have.
This list should include all over-the-counter medications, home remedies, and herbal medications including tea, vitamins and weight gain or loss products such as shakes, pills or bars. Sometimes they can be dangerous when you take them with other medications.

Know what medications you are taking, why you are taking them, and potential side effects. Let the doctor and nurse know of any allergies and type of reaction or side effects you have. Also be sure to ask questions about the medications you are prescribed during your appointment.

Safety Videos for Patients

Watch and learn valuable tips about how to be actively involved in your safety.

UC San Diego’s Practical Guide to Clinical Medicine

The Rest of the History

The remainder of the history is obtained after completing the HPI. As such, the previously
discussed techniques for facilitating the exchange of information still apply.

Past Medical History: Start by asking the patient if they have any medical problems. If
you receive little/no response, the following questions can help uncover important past events:
Have they ever received medical care? If so, what problems/issues were addressed? Was the care
continuous (i.e. provided on a regular basis by a single person) or episodic? Have they ever
undergone any procedures, X-Rays, CAT scans, MRIs or other special testing? Ever been
hospitalized? If so, for what? It’s quite amazing how many patients forget what would seem to be
important medical events. You will all encounter the patient who reports little past history
during your interview yet reveals a complex series of illnesses to your resident or attending!
These patients are generally not purposefully concealing information. They simply need to be
prompted by the right questions!

Past Surgical History: Were they ever operated on, even as a child? What year did this
occur? Were there any complications? If they don’t know the name of the operation, try to at
least determine why it was performed. Encourage them to be as specific as possible.

Medications: Do they take any prescription medicines? If so, what is the dose and
frequency? Do they know why they are being treated?* Medication non-compliance/confusion is a
major clinical problem, particularly when regimens are complex, patients older, cognitively
impaired or simply disinterested. It’s important to ascertain if they are actually taking the
medication as prescribed. This can provide critical information as frequently what appears to be
a failure to respond to a particular therapy is actually non-compliance with a prescribed
regimen. Identifying these situations requires some tact, as you’d like to encourage honesty
without sounding accusatory. It helps to clearly explain that without this information your
ability to assess treatment efficacy and make therapeutic adjustments becomes
difficult/potentially dangerous. If patients are, in fact, missing doses or not taking
medications altogether, ask them why this is happening. Perhaps there is an important side
effect that they are experiencing, a reasonable fear that can be addressed, or a more acceptable
substitute regimen which might be implemented. Don’t forget to ask about over the counter or
“non-traditional” medications. How much are they taking and what are they treating? Has it been
effective? Are these medicines being prescribed by a practitioner? Self administered?

* You’ll be surprised to learn how many patients don’t know the answers to these questions.
Encourage them to keep an up to date medication list and/or write one out for them. When all
else fails, ask the patient to bring their meds with them when they return or, if they are
in-patients, see if a family member/friend can do so for them.

Allergies/Reactions: Have they experienced any adverse reactions to medications? The
exact nature of the reaction should be clearly identified as it can have important clinical
implications. Anaphylaxis, for example, is a life threatening reaction and an absolute
contraindication to re-exposure to the drug. A rash, however, does not raise the same level of
concern, particularly if the agent in question is clearly the treatment of choice.

Smoking History: Have they ever smoked cigarettes? If so, how many packs per day and for
how many years? If they quit, when did this occur? The packs per day multiplied by the number of
years gives the pack-years, a widely accepted method for smoking quantification. Pipe, cigar and
chewing tobacco use should also be noted.

Alcohol: Do they drink alcohol? If so, how much per day and what type of drink? Encourage
them to be as specific as possible. One drink may mean a beer or a 12 oz glass of whiskey, each
with different implications. If they don’t drink on a daily basis, how much do they consume over
a week or month?

Other Drug Use: Any drug use, past or present, should be noted. Get in the habit of
asking all your patients these questions as it can be surprisingly difficult to accurately
determine who is at risk strictly on the basis of appearance. Remind them that these questions
are not meant to judge but rather to assist you in identifying risk factors for particular
illnesses (e.g. HIV, hepatitis). In some cases, however, a patient will clearly indicate that
they do not wish to discuss these issues. Respect their right to privacy and move on. Perhaps
they will be more forthcoming at a later date.

Obstetric (where appropriate): Have they ever been pregnant? If so, how many times? What
was the outcome of each pregnancy (e.g. full term delivery; spontaneous abortion; therapeutic
abortion).

Sexual Activity: This is an uncomfortable line of questioning for many practitioners.
However, it can provide important information and should be pursued. As with questions about
substance abuse, your ability to determine on sight who is sexually active (and in what type of
activity) is rather limited. By asking all of your patients these questions, the process will
become less awkward. Do they participate in intercourse? With persons of the same or opposite
sex? Are they involved in a stable relationship? Do they use condoms or other means of birth
control? Married? Health of spouse? Divorced? Past sexually transmitted diseases? Do they have
children? If so, are they healthy? Do they live with the patient?

Family History: In particular, you are searching for heritable illnesses among first or
second degree relatives. Most common, at least in America, are coronary artery disease, diabetes
and certain malignancies. Patients should be as specific as possible. “Heart disease,” for
example, includes valvular disorders, coronary artery disease and congenital abnormalities, of
which only coronary disease has genetic implications. Find out the age of onset of the
illnesses, as this has prognostic importance for the patient. For example, a father who had an
MI at age 70 is not a marker of genetic predisposition while one who had a similar event at age
40 certainly would be. Also ask about any unusual illnesses among relatives, perhaps revealing
evidence for rare genetic conditions.

Work/Hobbies/Other: What sort of work does the patient do? Have they always done the same
thing? Do they enjoy it? If retired, what do they do to stay busy? Any hobbies? Participation in
sports or other physical activity? Where are they from originally? These questions do not
necessarily reveal information directly related to the patient’s health. However, it is nice to
know something non-medical about them. This may help improve the patient-physician bond and
relay the sense that you care about them as a person. It also gives you something to refer back
to during later visits, letting the patient know that you paid attention and really remember
them.

Military Service: For obvious reasons, serving in the armed forces can be an important
period in someone’s life. In addition, inquiring about physical trauma, mental health issues
(PTSD, depression, substance abuse), and unusual exposures (toxins, infections) may reveal
important information.

In recounting their history, patient’s frequently drop clues that suggest issues meriting
further exploration. If, for example, they are taking anti-hypertensive or anti-anginal
medications yet made no mention of cardiac disease, additional history taking would be in order.
Furthermore, if at any time you uncover information relevant to the chief complaint don’t be
afraid to revisit the HPI.

The simple, powerful question doctors should ask their patients

As physicians, we are used to asking our patients lots and lots of questions. It’s our job to elicit information, listen, and then come up with a management plan. There’s a standard script every doctor goes through, based on the science of medicine, and we usually have this memorized to a tee. And that’s all very well and good. However, as with many things in life — especially those that involve human beings and an emotional (and dare I say, spiritual) component — it’s always more than just the science.

There’s one great question, however, that doctors utilize to a lesser degree than almost any other. And that’s a simple: “What are your goals?” This can come in a variety of different ways, such as: “What are you hoping for?” or “Where do you see yourself in one month?” It can be used at different points, depending on the circumstances — at the beginning of a discussion, before tests are ordered, or in the case of a hospital attending physician (which I am involved in most) — right upon discharge.

Asking this question has a number of positive effects:

1. It elicits extremely useful information

On a rudimentary level, this is obviously important information to know, for anyone involved in the patient’s care. Where are they coming from, and what are their goals? Do they expect to be pain-free in 1 week and back at work? Do they have to be up on their feet for their daughter’s wedding next month? This expectation level can then either be tempered, reinforced, or made even more optimistic!

2. It shows you care

Asking this basic question will immediately show that a doctor is curious and has a genuine interest in the patient. You are not just a “point-of-contact” person, but have taken the time to probe deeper. You are asking a question that helps foster empathy and compassion, the core of a better clinical interaction. Even in a social situation, anyone who is asked a question like this, responds positively because everyone likes and appreciates being able to articulate something that is important to them. And few things are more important than anybody’s health.

3. It gives the patient something to think about

Life is nothing without having goals and things to look forward to. Even if a patient struggles with this answer (rare), they will have something to ponder over. Hopefully, we are dealing with a reversible illness with light at the end of the tunnel. Even the thought of attending a Yankees game (sorry to anyone who is reading this not in New York, and hates this line), can motivate the patient immensely.

Time is a precious commodity in health care. It’s not something that any doctor has in abundance, or can afford to spend on random conversations (even if they really want to). But the above question may only take 2 or 3 minutes, and can have an immense effect, especially when a doctor is meeting a patient for the first time. And as with anything to do with communication, this does not mean asking a question in a robotic way! It has to come with the right level of emotional intelligence, and done with sincerity. If you are a doctor and already have this question in your repertoire, then well done. But as someone who coaches and teaches physicians communication skills, I am certain that very few ever make use of the simple “What are your goals?” question. Those goals or aspirations, may or may not otherwise come out organically during the discussion, but that’s left to chance.

So if you’re a doctor reading this, try it next time, even just once a day. You may be surprised with how much it’s appreciated. It’s one example of a small step that a physician (or any health care professional) can take, to improve their everyday communication skills. And there are dozens of more techniques like this that can help, many of which do not even involve asking questions, or take even a minute of extra time. All of these little things that help maintain the fast eroding doctor-patient human interaction, are healthy things to cultivate. Because they not only help make patients happier and more likely to have a better outcome, but also make the work of a doctor, a lot happier too.

Suneel Dhand is an internal medicine physician and author. He is the founder, DocSpeak Communications and co-founder, DocsDox. He blogs at his self-titled site, Suneel Dhand.

Image credit: Shutterstock.com

6 Healthcare Questions All Patients Should Ask their Doctor

Complicated paperwork, lengthy waits and concerns about your condition can increase your stress level when you visit the doctor. By the time your physician asks if you have any questions, you may feel so overwhelmed that you forget to ask about important issues. Preparing a list of healthcare questions in advance, including those listed below, will help you make the most of your time with the doctor and increase satisfaction with your experience.

1. What Is the Cause of My Disease or Condition?

Understanding the cause of your condition can help you make lifestyle changes that can prevent future problems. For example, your condition may be due to a vitamin deficiency from an unbalanced diet. Similarly, a chronic bronchitis diagnosis may make you realize that perhaps it’s time to give up smoking. Identifying the cause of your disease or condition can also help protect your family members’ health, particularly if you have an inherited condition.

2. Are There Alternatives to the Proposed Treatment?

It’s crucial to make sure that you fully understand all of the treatment or pain control options. If your doctor doesn’t mention alternative treatments, make sure you ask if other options exist. Find out why your doctor recommends one particular treatment over another and ask about the side effects of any medication he or she prescribes.

3. What Is the Success Rate of This Treatment?

If your doctor does recommend a particular treatment, it may be because the success rates are particularly impressive. A discussion about treatment success rates can help you weigh the benefits of the treatment against any risks. In addition to asking about the success rate, ask your doctor how much he expects the treatment to help your condition or disease and if results are likely to be short-term or permanent.

4. What Are the Risks of This Treatment?

Almost every treatment or medication comes with risks or side effects. A frank discussion of the benefits and risks can help you decide if the treatment is the right one for you. Although a treatment or medication may list warnings of serious health problems, these issues often only occur in a very small percentage of cases. Obtaining accurate information on the frequency of side effects and successful outcomes is essential when you make a decision about a treatment or medication.

5. How Can I Improve My Health In the Short- and Long-Term?

No matter how successful a treatment or medication, the results won’t matter much if the same problem crops up again a few weeks or months down the road. Ask your doctor for preventive care recommendations that will help you improve your health not only in the coming weeks, but in the coming years. Find out if there are specific symptoms that could indicate that your problem is returning or worsening, and ask what you can do to prevent or reduce these symptoms.

6. What Are the Next Steps?

Before you leave your doctor’s office, you should know exactly what will happen next. If your doctor wants you to see a specialist, ask if his or her office will make the appointment or if you should contact them on your own. Find out if your doctor needs any information from you, such as a release to obtain medical records from another physician. Ask when you should return for a follow-up visit and if you should undergo any type of testing before your next appointment.

An ideal doctor/patient relationship is based on shared decision making, so you and your doctor should work as a team to decide on the best treatment options. As the most important member of this team, it’s essential that you make sure that you’re fully informed about your diagnosis and completely understand all of your options.

Looking for a more comfortable doctor’s visit? Learn more about our patient comfort solutions and ask your doctor if they are right for you.

10 Questions Some Doctors Are Afraid To Ask : Shots

Imagine that the next time you go in for a physical, you’re told there’s a new tool that can estimate your risk for many of the major health problems that affect Americans: heart disease, diabetes, depression, addiction, just to name a few.

It’s not a crystal ball, but might hint at your vulnerability to disease and mental illness — long before you start smoking or drinking, gain a lot of weight, develop high blood pressure or actually get sick.

And all you have to do is answer 10 yes-or-no questions about your childhood:

First developed in the 1990s, these 10 questions of the Adverse Childhood Experiences test are designed to take a rough measure of a difficult childhood.

Answering those questions would give you an “adverse childhood experiences” score (or ACE score, for short). The test’s proponents say that it provides a rough measure of a tough childhood, and some of the experiences — death of a parent, childhood abuse or neglect — that can have long-term effects on your health.

Dr. Vincent Felitti of the University of California, San Diego, who did much of the research that gave rise to the ACE score, thinks the tool is so useful it should be part of a routine physical exam. But it’s not, for a variety of reasons.

For one thing, doctors aren’t taught about ACE scores in medical school. Some physicians wonder what the point would be, as the past can’t be undone. There also is no way to bill for the test, and no standard protocol for what a doctor should do with the results.

The ACE score is still really the best predictor we’ve found for health spending, health utilization; for smoking, alcoholism, substance abuse. It’s a pretty remarkable set of activities that health care talks about all the time.

Dr. Jeff Brenner, family doctor and MacArthur Fellow

But Felitti thinks there’s an even bigger reason why the screening tool largely has been ignored by American medicine: “personal discomfort on the part of physicians.”

Some doctors think the ACE questions are too invasive, Felitti says. They worry that asking such questions will lead to tears and relived trauma … emotions and experiences that are hard to deal with in a typically time-crunched office visit.

I wondered if those concerns were warranted, so with the permission of the patient and the doctor, I sat in on an appointment.

Bonnie Ratliff, a mother of two in her 30s, met with Felitti at Kaiser Permanente in San Diego, where he did his research more than 15 years ago with the Centers for Disease Control and Prevention.

As Felitti talked with Ratliff, he went over the extensive, customized medical history form she’d filled out before the appointment — a form that included the ACE questions. Felitti asked Ratliff about her mother’s nervous breakdown, and the drinking and hoarding that followed it.

“It was hard, you know? It was especially hard because she made us keep it a secret,” Ratliff said.

Ratliff also explained that she was molested once, as a kid, although she didn’t think that had affected her in a lasting way.

It took about a half hour to go over everything — which included some issues with irregular heartbeat, weight gain, allergies and an eye problem, in addition to the questions about Ratliff’s childhood. It took a bit longer than a typical doctor’s appointment, but otherwise wasn’t so different. Despite the intimate content of the conversation, Ratliff never got upset.

“You don’t feel like you have to bare your emotions, you know?” Ratliff said afterward. “If it’s just, like, just a checklist, and you can just check off these things that have happened to you — ‘yep, yep, yep’ — it doesn’t feel so scary.”

Felitti hadn’t even mentioned the term “ACE score,” or told Ratliff what her score was — 4 out of 10 — but he methodically had asked her how she thought each adverse childhood experience had affected her. After the appointment, Ratliff said that as she spoke with Felitti, something clicked into place.

“I’ve done a lot of thinking about how my childhood experiences have turned me into the person I am, how I still carry them with me,” she said. “I haven’t necessarily connected it, for the most part, to physical issues before this.”

That’s the point, Felitti believes: Asking patients about ACEs helps patients understand their health more deeply, and helps doctors understand how to help.

There are no randomized controlled trials that show that applying these screening tools to a large population changes any outcomes that a patient cares about. Someone’s got to show me that it’s going to actually make a difference in my patients’ lives.

Dr. Richard Young, Family Medicine, Fort Worth

According to Dr. Jeff Brenner, a family doctor and MacArthur Fellows award-winner in Camden, N.J., getting these rough measures of adversity from patients potentially could help the whole health care system understand patients better.

The ACE score, Brenner says, is “still really the best predictor we’ve found for health spending, health utilization; for smoking, alcoholism, substance abuse. It’s a pretty remarkable set of activities that health care talks about all the time.”

Brenner won his MacArthur fellowship in 2013 for his work on how to treat the most complicated, expensive patients in his city — people who often have high ACE scores, he found.

“I can’t imagine, 10, 15 years from now, a health care system that doesn’t routinely use the ACE scores,” he says. “I just can’t imagine that.”

Brenner only learned about ACE scores a few years ago, and says he regrets not integrating the tool into his practice sooner. But like most doctors, he says, he was taught in medical school to not “pull the lid off something you don’t have the training, time or ability to handle.”

In theory, Brenner says, talking to patients about adverse childhood experiences shouldn’t be any different than asking them about domestic violence or their drinking — awkward topics that doctors routinely broach now.

But spreading the word about ACE scores has been a challenge, he says.

Even doctors who want to screen their patients in this way say that figuring out exactly how to do so is complicated. Who would review the answers with patients? A doctor? A nurse? A social worker? And what should doctors do with a patient’s ACE score, once they have it?

“You can’t go back 40 years and make the bad childhood go away,” says Dr. Richard Young, a family physician who also trains residents in family medicine in Fort Worth, Texas.

Young says he sees patients all the time with lots of health problems who had rough childhoods — and he’s not afraid to talk to them about what they’ve been through. But he’s skeptical of the usefulness of asking every single patient about adverse childhood experiences.

For those who already have reckoned with demons from their past, the questions could bring up issues they’d rather not relive, Young says. And many of the biggest factors that can foster disease and shorten life — depression, alcoholism, drug abuse, and complicated, chronic conditions like diabetes and obesity — are problems he says he would find out about anyway, without having to ask patients about their childhoods.

“There are no randomized controlled trials that show that applying these screening tools to a large population changes any outcomes that a patient cares about,” says Young. “Someone’s got to show me that it’s going to actually make a difference in my patients’ lives — and to my knowledge no one has done that.”

Felitti agrees that there is no research tracking how asking for ACE scores affects patients in the long term, but says that from his experience with many thousands of patients, the benefits of getting an ACE score come down to something more spiritual than medical: alleviating shame.

Felitti says that many of his patients never had told anyone that they’d been abused as a kid — ever — until he asked them. Disclosing their secrets, they told him afterward, brought them tremendous relief.

He likens that unburdening to a lay version of a Catholic church confession.

“They leave with the understanding that they’re still an acceptable human being, they’re still part of the group,” Felitti says.

Instead of treating a specific medical problem, talking about an ACE score with a patient is a process of listening and accepting, Felitti says. But for busy doctors eager to diagnose and cure, that’s harder than it sounds.

This story is part of the NPR series, What Shapes Health? The series explores social and environmental factors that affect health throughout life. It is inspired, in part, by findings in a poll released Monday by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health.

Questions Are the Answer to Helping Patients Understand Their Health

By Helen Osborne, M.Ed., OTR/L
President of Health Literacy Consulting
On Call Magazine, June 25, 2008

The U.S. Agency for Healthcare Research and Quality (AHRQ) is charged with improving the quality, safety, efficiency, and effectiveness of healthcare for all Americans. So why is AHRQ producing “Questions Are the Answer” — an upbeat, musical consumer campaign that encourages patients to ask questions?

Getting patients involved

Carolyn M. Clancy, MD, is director of AHRQ. She explains that “Questions Are the Answer” aims to reduce the number of preventable harms happening to patients each year. Data from the Institute of Medicine’s report To Err Is Human show that approximately 120 people each day die from preventable harm. That’s more than 43,000 people each year who die from medical mistakes that do not need to happen.

The “Questions Are the Answer” campaign builds on what patients and providers agree is important — that patients should be involved in their own healthcare. Involved patients tend to have better health outcomes, and asking questions is an important, though admittedly basic, way to be involved. “Yes, it is straight forward. But people don’t do it. This is a huge opportunity,” says Clancy.

Cindy Brach, a Senior Health Policy Researcher at AHRQ, tells a sad story that illustrates the importance of overcoming cultural as well as communication barriers. Spanish-speaking parents brought their teenage son to an emergency room because of some concerning symptoms. Without an interpreter, there was miscommunication about the symptoms and doctors treated the teenager for a drug overdose. The parents knew their son, an anti-drug athlete, had not taken drugs. But they felt it was disrespectful to question the doctor and so stayed silent. The boy was later diagnosed with a brain aneurysm and is now quadriplegic. Brach says that it’s important to make clear that asking questions is neither rude nor insulting. AHRQ has just launched a Spanish-language campaign, “Sea un Superhéroe” (Be a Superhero) that underscores the message that providers want and expect patients to ask questions. Like “Questions Are the Answers,” it includes a list of questions patients can use to know what to ask doctors.

Multiple resources from multiple partners

“Questions Are the Answer” was developed by AHRQ in conjunction with the Ad Council, explains Allan Lazar. Lazar is AHRQ’s director of communications and knowledge transfer. The campaign was launched in March 2007 and is funded largely by donations of time and talent from the advertising industry and media outlets. “Questions Are the Answer” includes several components:

• Web site. The Web site has a plethora of practical consumer information, including “5 Steps to Safer Healthcare,” “20 Tips to Prevent Medical Errors,” and links to both a resource list and a glossary of “How to Speak Health Care.”
• Question builder. On the Web site is a question builder — an extensive listing of important questions plus a way for people to choose which ones they need to ask their healthcare provider. Once people have picked their questions, they can print them. The page they get is already formatted with space to write the answers.
• Video. Honestly, this video is my favorite way to highlight the importance of question-asking. I often show it in health literacy presentations. The video is musical, memorable, and extremely well done. You can access both the 60-second and 30-second versions on the Web site.
• Other formats. “Questions Are the Answer” information is available in formats suitable for television, radio, newspapers, magazines, the Web, and outdoor advertising. Lazar says that media outlets have so far donated more than $27 million worth of free advertising to this campaign. It is also shown on the Patient Channel (satellite television) in 1,700 hospitals and reaches nearly 15 million patients across the country.

Helping patients use questions to better understand health information

Clancy, Brach, and Lazar all have suggestions about how clinicians can use “Questions Are the Answer” to help their patients better understand health information.

Be a voice of encouragement. It almost always feels intimidating to be a patient. One reason is that hospitals, clinics, and other healthcare settings are busy places with many professionals bustling about. “This obviously doesn’t invite patient engagement,” says Clancy. “As a doctor, we send many signals to not interrupt the flow.”

Patients not only can feel intimidated by the environment but also forget what questions they wanted to ask. “In the office, these questions can go out the window,” says Clancy. She recommends that clinicians encourage patients to make a list of questions ahead of time. This way, they have a “roadmap” for what they want to learn more about and discuss with their providers.

Elicit questions in helpful ways. Many patients are reluctant to ask questions of health care providers. Clancy cites an unpublished study showing that men, in particular, ask few questions. From the time they arrive at a healthcare setting until they leave, men ask an average 1. 4 questions (and this includes questions about parking!).

Brach recommends providers elicit questions with open-ended phrasing such as “What are your questions?” This lets patients know that questions are expected, as opposed to what happens when you ask almost rhetorically, “Do you have any questions?” Providers can also help patients think of what to ask by referring them to the question builder on the “Questions Are the Answer” Web site. You can learn more about other ways to elicit questions by going to “In other words…Helping Patients Ask Questions.”

Consider “Questions Are the Answer” as a checklist of topics to discuss. Brach cites research showing that over 50% of the time physicians do not give specific dosing directions to patients when prescribing a new medication. She says that the topics on “Questions Are the Answer” cover core information that providers need to communicate and patients must understand.

Create systems to accommodate questions. Question-asking is the responsibility of both patients and providers. “I would love to see more practice settings where patients’ questions and need for information are anticipated and done upfront,” says Clancy. She believes that if basic questions are dealt with first, there will be more time to then focus on each patient’s unique needs.

Of course, time (or lack thereof) is a concern for all providers. Brach recommends that healthcare administrators consider who else, other than doctors, can answer patients’ questions. When she sees one of her doctors, Brach says the doctor is with her for just a short time while the nurse remains to answer questions and review medication instructions. Brach recommends that practices look for efficient ways to answer questions as patients move through the system.

Verify and confirm understanding. Confirming patient understanding is an essential part of all health communication. Clancy, Brach, and Lazar agree that it is one thing for patients to ask questions and another to make sure they understand the answers. One way to confirm understanding is by using the teach-back technique. This happens when clinicians ask patients to state in their own words (teach-back) key points just discussed. Brach finds that many providers are good at explaining information but less skilled at confirming understanding. To learn more about the teach-back technique, go to “In Other Words…Confirming Understanding with the Teach-Back Technique.”

“Questions Are the Answer” is more than just a campaign about asking and answering questions. Lazar says that when patients ask questions of their providers, they clearly communicate the message, “I am interested in my own healthcare and want to take care of my health.”

Ways to learn more:

Questions Are the Answer website

To learn more, contact Allan Lazar at [email protected]

Helen Osborne, MEd, OTR/L, is president of Health Literacy Consulting. She received two “Gold 2008 Plain Language awards from NIH for her work on the NCI booklets “Radiation and You” and “Chemotherapy and You. ”Her column appears regularly in On Call. You can contact her by e-mail at [email protected].

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90,000 10 doctor’s questions that should be answered truthfully, even if you are ashamed and embarrassed

Patients hide information from their doctors for a variety of reasons. Many people feel embarrassed or uncomfortable when answering personal questions, some believe that some details are just not so important. But any, in your opinion, little things or your personal “secrets” can affect your health, and therefore should be brought to the attention of the doctor.

Bright Side collected questions that need to be answered honestly, without distorting anything or keeping silent.

1. How long has it hurt

Very often patients are drawn to a visit to the doctor, citing lack of time or secretly dreaming that everything will pass by itself. And when they come to the appointment, they fear that the doctor will scold them for not coming earlier. Therefore, answering the question “How long does it hurt?”, Patients deliberately shorten the period of illness. You should not do this in any case: you are misleading the doctor, which means that the diagnosis and treatment may also turn out to be wrong.

2.When was the last time you took tests and did an ultrasound scan

If you feel well overall, doctors recommend that you undergo an examination every 1-3 years. A routine blood test can show your baseline health. But many of us do not take tests for years, and if they do, they often do not bring the results of past tests with us to the appointment. For example, if a cyst is found in you, then it is important for the doctor to at least approximately establish the period of its formation and track the dynamics of its development.If you say: “I had an ultrasound scan last year, and nothing was revealed” – but in fact, you did it several years ago, then this will not bring you closer to recovery.

3.

What medicines, vitamins and dietary supplements do you take

Unlike drug manufacturers, supplement manufacturers do not have to clinically prove that their products are safe or effective. Even if these dietary supplements are exclusively natural, they can have a strong effect on the body. Some of them may interact with medications you are taking or may be harmful in high doses.If you often wash down a headache or stomach discomfort with pills without a prescription, do not forget to voice all this to your doctor.

4. Information about sex life

Questions from a gynecologist or urologist about your sex life are quite natural, and there is no need to be ashamed. We are all adults, so distortion of any information is not in your favor. For example, pain in women during intercourse can be a minor problem solved by a purchase at a pharmacy, or it can be the cause of serious illness.Hence the doctor’s interest in your sacred area of ​​life.

5.

How often do you drink, smoke or take illegal drugs

Information about alcohol will be useful to your doctor, for example, to check your liver function or the risk of ulcers. It is necessary to tell the doctor even about small amounts. Many medications, when combined with alcohol, lead to unpleasant consequences. And besides the obvious risks, there are also a bunch of pitfalls that we have no idea about. Behave like an incorrigible pedant: tell me how many cigarettes you smoke a day and how many glasses you drink.So, by the way, it will be easier for the doctor to work with you to develop a plan for dealing with addiction, if any. Of course, we must also say about drugs. The doctor does not need the details of where you got them and what kind of scoundrel sold them to you, it is enough to name the substance and the frequency of use.

6. Do you have depression

If things are not going well, you are not in the mood, tell your doctor about it. Try to fully describe how you feel, even if it is difficult to find the right words.An attentive therapist will be able, if necessary, to gently suggest that you go for a consultation with a therapist. And don’t be afraid. It is not at all a fact that you have depression. Sometimes a bad mood is due to hormonal disruption or something else, so let the experts figure it out.

7. Do you follow the doctor’s orders

Many people simply forget to take their medications, and some medications may taste bad. But these problems should not be kept silent.The doctor may suggest that the treatment is not working, suggest increasing your dose, or prescribing new drugs. And knowing about the uncomfortable moments for you, the doctor will be able to offer alternative treatment.

8. How do you sleep, do you have insomnia

You may think that the issue of sleep is not so important, that it will pass or it is just a factor of aging, and therefore there is no need to bother the doctor. But poor sleep can be the cause of stress, depression, menopause, or chronic illness.Tell your doctor about your problems so they can assess the problem and find out the root cause.

9. Do you feel constant fatigue

Be sure to tell the doctor about such “little things” as drowsiness, fatigue, apathy. Especially if they weren’t there before. It happens that these symptoms can be easily treated with healthy sleep, balanced diet and exercise. But fatigue can also cause serious health conditions such as anemia or sleep apnea, so don’t be afraid to share honestly with your doctor.

10. Do you understand everything

Professional terms or a large amount of information can easily confuse you, so do not be afraid to ask questions or clarify those moments of treatment that remained misunderstood.

How to prepare for a visit to the doctor

In order not to forget anything, it is better to prepare for the appointment in advance, writing down the following points on paper:

• symptoms: how often and how long they last;
• Remember hereditary diseases that your next of kin were ill with;
• Write down the names of the medicines you are taking and their dosage;
• Prepare copies of your recent test results.

If your doctor interrupts you, politely ask for a little extra time to get all your questions answered. Don’t be afraid to ask for clarification. Cherish your health and do not get sick!

What do you think could help in communication between doctors and patients so that they could be more trusting?

Communication tool

When communicating with a patient, a doctor always faces a problem: is everything he asked is clear to the patient.The magnitude of this problem is well reflected in an experiment conducted by one American doctor on the topic “Do our patients understand everything when communicating with a doctor?” Experienced doctors were gathered for its implementation. They asked a number of questions to patients suffering from various diseases of the digestive system. A group of expert doctors oversaw their conversation. The result of the experiment was as follows: the patients did not understand more than 80% of the questions asked by the doctors. Why is this happening, why patients do not always understand what exactly the doctor wanted to know from him, and as a result, they give the wrong information that was needed? The answer is simple: you need to be able to ask questions.You will learn how to master the technique of using the communication tool – the art of asking questions correctly – from the article by the professional psychologist A. Zh. Monosova, Ph.D. D., founder, development director of the training company ArsVitae, Moscow.

Asking Questions

In the last issue of the journal, we got acquainted with how to influence the effectiveness of interaction with a patient by choosing a psychological position. In this issue we will consider one of the most important tools for managing the psychological position of the interlocutor – questions.

We have been asking questions every day since early childhood.

• What is it?
• Why is this happening?
• What is the name of this body?
• How does the digestive system work?
• Do you want to feel better?
• Etc., Etc.

Today we will structure this skill and analyze how, using this powerful tool, not only to learn information, but also to purposefully manage the psychological position of the interlocutor and the conversation as a whole.

Questions

For convenience, we systematize the questions:

1. The most famous classification of questions “by form” identifies open, closed, alternative questions.

Open-ended questions begin with interrogative words “how”, “what”, “where”, etc. Open-ended questions allow you to find out more information and are usually used at the beginning of a contact.

Example:

“How do you feel?”

Closed-ended Questions are, in fact, statements that are asked using interrogative intonation and which can only be answered “yes” or “no”.

Example:

“Did you follow your diet today?”

Alternative questions contain at least two possible answers in the wording and are built using the conjunctions “or”, “or”.

Example:

“Does heartburn appear before or after eating?”

When collecting information at the very beginning of the dialogue, as a rule, open questions are asked, then alternative ones, and at the very end – closed clarifying questions.You can think of it as a funnel – a tool with which we can move matter from a large volume to a smaller one. We start by capturing as much information as possible (for example, “How are you feeling?”), Then narrow the information down with an alternate question (for example, “Has the feeling of weakness increased or decreased since the last visit?”) And conclude with a clarifying closed-ended question (for example, “More all the dizziness after eating bothers you at the moment? “).

If we immediately start clarifying information with closed questions, then it is quite possible that we will never guess the true information.Our attempts will either fail altogether (“Well, are you feeling more cheerful?” In a situation when your cheerfulness has not increased), or they will discover the presence of incomplete information (“Dizziness in the morning has stopped?” In a situation where the morning dizziness really disappeared, giving way to fainting after breakfast).

However, the form of the questions affects not only the volume and quality of the information received, but also the behavior of the interlocutor as a whole.

Open-ended questions literally open up a person, he actively and willingly answers, starts talking more.And closed questions are closed. Therefore, in order to get your interlocutor to talk, ask open-ended questions (for example, “What do you think about this?”), And in order to curtail his speech, ask closed-ended questions (for example, “Do you understand the recommendations?”).

Watch how this happens in life (for yourself, colleagues, friends), and you will see that very often we do the opposite. We ask closed questions in the hope of getting the interlocutor to talk and we are surprised that he only nods and answers in monosyllables.Or we continue to ask open-ended questions when we just need to end the conversation. And we are just as surprised at the talkative interlocutor.

2. The next classification that we need to achieve the goals is the classification of questions “by content”. We will distinguish between two types of questions – about fact and about opinion.

Fact questions ask for objective information (for example, “What is your weight now?”).

Opinion questions ask for subjective information (eg, “Are you satisfied with your weight?”).

There are also questions that are misunderstood as questions of fact. For example, “Are you overweight?” Hearing “yes”, you will only know that the patient considers his weight to be large, and nothing more. However, a common response from a questioner is to interpret “high weight” using their criteria. This is how most of the distortions in the transmission of information appear. Sample questions:

• Do you often go to the clinic?
• Do you have a large family?
• Do you eat a lot?
• Etc.d.

All these questions are about opinion. Having heard the answer to them, we learn the subjective idea of ​​the interlocutor. And we can find out objective information only by finding out its criteria (“What do you consider a large portion?”) Or by asking a question about the fact (“How many grams / calories is your usual portion?”).

So, questions about opinion help to collect subjective information, to find out about the patient’s attitude to something.

The patient will most likely answer these questions by expressing his own opinion (“often, for a long time, quickly”).To find out specific, objective information, you need to ask questions about the fact.

Example: “Do you have severe blood pressure?”, “Have you recently changed your diet?”, “Are you overweight?”

Example: “What is your highest blood pressure?”, “When did you change your diet?”, “How much do you weigh?”

These questions encourage the patient to speak with facts (“twice a day, a month ago”).

The choice of the content of the question, as well as its form, affects not only the receipt of information, but also the course of the conversation.

Questions about a fact direct the conversation in a certain direction, make the interlocutor be specific.

On the contrary, questions about opinion allow the interlocutor to express themselves as vaguely and for a long time as they like.

Therefore, if you want the interlocutor to talk, talk, speak, ask about his opinion. If you need a clear and concise answer, ask the facts.

3. The third classification, which is necessary for the exact solution of our problems, is the classification of questions “by direction”.We will highlight neutral and pressing issues.

Neutral Questions have no connotation – they really ask what is being asked. For example, “What time is it?”, “What did you eat for breakfast?”

Leading or pressing questions contain a subtext, a hint, they seem to push you towards a definite answer. For example, “Well, what time is it now?”, “And what did you eat for breakfast today?”

Neutral questions are asked from the Adult position and are addressed to the Adult in the interlocutor.Pressing questions are pronounced by the Parent, addressing the Child in the interlocutor. Therefore, neutral questions encourage responding from an Adult position – neutral, concrete, objective. For example, “It’s five minutes past three”, “I ate a plate of porridge and a cheese sandwich.”

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Pressing questions provoke the interlocutor either to make excuses from the Child’s position (for example, “Well, I couldn’t have come earlier”, “Yes, I already eat almost nothing at all”), or to resist with the Parental one (for example, “And what, actually, business? “,” Well, probably not your notorious diet, from which you can stretch your legs! “).

Some pressing questions stop communication altogether, breaking contact or provoking a violent conflict.

Therefore, if we want to receive information, keep in touch and communicate in the partner Adult position, we use neutral questions.

Table 1. Classification of questions “by form”

Psychological position management

So, we have analyzed and structured the habit of asking questions.You will be able to use it not only to obtain information and control the conversation, but also to control the psychological attitude of your interlocutors.

To actualize the adult position, it is necessary to turn the interlocutor to facts, analysis. Therefore, the question should be:

• open – to stimulate the search for information;

• necessarily about fact – to awaken the analytic Adult role;

• necessarily neutral (a pressing question is a manifestation of the Parental position, which in response will cause a Child or Parental position).

For example, let’s take an “irresponsible” patient to the Adult position, who did not follow the diet and complains at the reception that her condition has not improved.

Patient: Doctor, I didn’t have time to buy the necessary products. I got bogged down completely – so many things after the hospital And then I found out the unpleasant news, I felt so bad, worried, the pressure jumps.

Doctor: How exactly does it ride?

Patient: Well, it has risen strongly.

Doctor: What pressure did you have when the ambulance arrived?

Patient: 250 at 110.

At this point, the patient has already switched to the Adult position, and a meaningful conversation can be conducted with her. You can ask 1-2 more questions to reinforce her objectivity.

Doctor: With what pressure did you come to us last time?

Patient: 270 at 120, it seems there was.

Doctor: What did you eat for breakfast yesterday?

It is in a situation of impossibility of control (treatment takes place already at home) and the patient’s tendency to shift responsibility for her condition onto external circumstances and other people, it is very important to secure this responsibility – on the patient herself or, if her well-being requires it, on relatives who are able to completely take take control. Based on this goal, the doctor should not be persuaded (“Why are you so, you must definitely follow the recommendations”), supporting the child’s position of the patient.

Table 2. Questions to the patient

Errors in using questions to bring the interlocutor to the Adult position

1.Outwardly neutral questions containing persuasive arguments.

“What did you eat for breakfast if you felt so bad?”

The interlocutor perfectly recognizes the next arguments in questions and continues to argue with them.

2. A stream of questions that the interlocutor does not have time to answer.

In this case, it is especially important to let the interlocutor answer. His Adult position is not activated by the sound of your voice, but by his own thoughts that arise in search of an answer.

3. Bringing the patient to the Adult position in a situation when you want him to do something without hesitation, without unnecessary questions.

In such cases, an order or just a request will work better. Always keep in mind the purpose of your intervention and the response you want from the patient.

4. Use of questions in a situation when the interlocutor is not just not an Adult, but is also in an aggressive state.

For such situations, you will need tools for working with negative emotions, which we will talk about in the next issues of the magazine.

Conclusions

We have disassembled with you the tool “questions”, which will help you manage and receive information, and the course of the conversation, and the psychological position of the interlocutor. The tool is familiar to you, try to apply it from a new angle and watch the results.

In the next issues of the journal, we will continue to analyze aspects of communication with patients and communication management tools.

Fomin’s Clinic – a network of multidisciplinary clinics

A visit to a gynecologist often turns into a test.The doctor asks unpleasant questions, dictates his own terms and imposes authority – while it is completely unclear whether he is right in this situation or not. We will tell you how a communication with a gynecologist can look like, which does not give the patient discomfort, and how to arrange it in order to get the maximum benefit from the appointment.

In March 2006, doctors from the famous American Mayo Clinic interviewed 192 people to find out what qualities, in their opinion, the ideal doctor should be.The list of requirements included only seven items:

• Confidence in yourself and your knowledge. The doctor’s “fighting spirit” instilled in patients hope for recovery and increased confidence in the doctor.
• Sensitivity. Patients appreciate it when the doctor tries to understand what they are experiencing on a physical and emotional level, and saves them unnecessary suffering.
• Humanity. People who come to the reception expect that the doctor will be caring, show compassion and kindness to them.
• Personal approach.It turned out to be important for the patients that the doctor saw them as a person with their own character, interests and destiny, and not just an “interesting medical case.”
• Honesty. Patients prefer to know the truth and appreciate it when this truth is explained in an accessible language.
• Respect. Patients expect that the doctor will give them the opportunity to independently make decisions about their health – to discuss treatment and a convenient time for testing.
• Good faith. Patients hope that the doctor will walk with them to the end, from diagnosis to rehabilitation.

When patients were asked to sketch a portrait of the “worst doctor”, it turned out that the most painful people react to arrogant doctors who are not interested in the opinion of the wards. Study participants particularly disliked when the doctor ignored questions and showed indifference when announcing a difficult diagnosis.

The international medical community is interested in the fact that when communicating with patients, doctors try to get closer to the ideal. To help doctors, experts create instructions and guidelines on how the doctor should behave at the appointment.It is also useful for patients to know about this.

Back in 1996, specialists from the Faculty of the University of Cambridge, together with experts from the Canadian city of Calgary, developed a comprehensive guide for doctors that describes how a doctor should behave at an appointment – the Calgary-Cambridge Model of Medical Consultation.

According to this model, the doctor must not only structure the appointment in order to extract the maximum information from the visit, but also competently build a relationship with the patient.This is what an ideal doctor’s appointment should look like:

• Start your consultation. You enter the office. The doctor meets you: introduces himself and asks for your name. At the same time, it is important that the doctor is distracted from the papers and the computer – to make you more comfortable at the appointment, the doctor is advised to look you in the eyes.
• Collection of information. The doctor offers to sit down, asks about the purpose of your visit and begins to collect anamnesis – information about your health. At the same time, the gynecologist behaves kindly, politely and correctly – this includes, among other things, attention to your physical comfort.For example, the doctor should not send you behind the screen immediately, as soon as you crossed the threshold of his office. According to the Calgary-Cambridge Model, the doctor should talk to you while you are fully clothed – few people are comfortable talking to a doctor while sitting in a gynecological chair.
• Physical examination (physical examination). Having collected anamnesis, the doctor proceeds to the examination. Only an assistant or nurse can be present during the examination. During the examination, the doctor should take into account your comments and requests and try to cause a minimum of inconvenience.
• Explaining and planning. After completing the examination, the doctor should explain what is happening to you. It is important that the explanation is clear and accessible, without medical jargon. If questions remain, the doctor must answer them. It is not always possible for a doctor to make a diagnosis after the first visit. Often this requires additional tests and examinations. In this case, the doctor must explain what tests need to be passed, what they are for and what their results mean. After the doctor has all the information necessary for making a diagnosis, he must offer a course of treatment.If there are more than one treatment option available, the doctor must explain them all, explaining their pros and cons, and give you the opportunity to choose the one that suits you. But that’s not all. The doctor should tell you what his recommendations are based on. It is important that in doing so it is based on international clinical guidelines and scientific evidence. The personal opinion and experience of a doctor is not enough to make a decision.
• Completion of the consultation. At this stage, the doctor explains the treatment plan and agrees with you about the next steps: for example, he sets the date of the procedure, which must be arrived at a certain time.The doctor then needs to make sure you understand what to do next and agree with the proposed treatment. The doctor then asks again if you have any questions and ends the consultation.

In this case, it is very important that the doctor behaves not like an all-knowing luminary, but like a benevolent partner. Even if the doctor is experienced and smart, like Dr. House from the series, but the patient does not trust him and does not follow the recommendations, then there will be little benefit from the treatment.

This is what the authors of the book “Patient Communication Skills” have to say about this: “There is little sense in being a brilliant diagnostician or possessing extensive factual knowledge if you do not delve into the most important problems of the patient.”

Unfortunately, both in our country and abroad, doctors are little taught about emotional participation and communication with the patient. The traditional clinical method is based on scientific thinking, therefore, teachers of medical schools of the “old school” appreciate the composure and detachment in doctors. This means that young doctors from college students are taught to behave with restraint – including so that they do not burn out emotionally.

In addition, doctors’ appointments are often limited in time.In order to have time to receive all the patients, they have to hurry up and “squeeze” the reception in order to have time to examine the patient and give her recommendations.

At the same time, doctors are sincerely eager to help. A large study found that 75% of doctors believed they were good at communicating with the people who came to see them. But only 21% of patients agreed with them.

This does not mean that you have to endure treatment that you do not like. Since doctors often do not even know what they are doing to the patients unpleasantly, in order to stop it, it is often enough to tell them about it.

Do not hesitate to remind your doctor about your needs. All you need to do is ask a few simple questions.

“Doctor, please explain why you are asking me this question?”

At times, the questions a doctor asks for taking an anamnesis can seem painful and too personal. For example, your doctor may ask when you last had sex, how you protect yourself, whether you have had pregnancies or miscarriages, and whether you plan to get tested for sexually transmitted diseases.

As a rule, the answers to these questions are needed in order to correctly diagnose and plan treatment. In any case, the gynecologist is obliged to clearly and directly answer for what purpose he asks the question and how he intends to use the information received.

“Please tell us why you offer me this particular treatment?”

By asking this question, you will be able to find out what information the doctor relies on and how much evidence his approach is. On the other hand, the doctor will understand that he did not express himself clearly enough, which means that he could be misunderstood.Hearing your question, the gynecologist will be able to better explain his position.

So, gynecologist Oksana Bogdashevskaya in an interview for apteka.ru tells why gynecologists strongly recommend young women to give birth. The fact is that a woman’s ovarian reserve is quickly depleted, which increases the risks of pregnancy pathology – up to infertility. Gynecologists sincerely try to protect patients from such risks, but the advice “to give birth as soon as possible” still sounds rather tactless.

The best thing to do in such a situation is to ask the doctor not to touch your personal life and not to give you recommendations. If you come to your appointment with a problem not related to infertility, you have the right to refuse information that you do not need right now. It is the doctor’s responsibility to take into account your wishes and your appointment plans.

“Thank you for your welcome. Could you answer a few more of my questions? ”

This question will help you avoid disappointment and confusion after the consultation.Studies show that doctors often think that the first question asked at a consultation is the most important one, and do not listen to patients to the end. At the same time, patients often come to doctors with several complaints at once, and they do not necessarily talk about the most serious problem in the first place.

Even if the doctor is in a hurry, do not hesitate to ask him additional questions. If you are afraid to forget about everything you wanted to ask, it is better to write down the questions before consulting a doctor.

“Doctor, I cannot afford such an expensive treatment. Are there any alternatives? ”

Do not be shy about this question. Doctors, especially in private clinics, do not always understand when a patient is unable to afford treatment. A good doctor is usually eager to offer the patient the most advanced therapy – and often it is quite expensive.

At the same time, the doctor is interested that his recommendations are followed. Typically, most treatments have less expensive alternatives: for example, the original drug can often be replaced with a generic drug — a cheaper copy drug with a similar formula and effect.Most importantly, be sure to ask your doctor to explain the pros and cons of alternative treatment options.

Important! If the doctor is annoyed and refuses to answer your questions, this is a bad sign. In this situation, it makes sense to write a statement addressed to the head physician and describe the problem, or contact the insurance company (especially if you are undergoing treatment under the compulsory medical insurance policy).

If you do not want to waste time and energy, it may make sense to ask for a second opinion and look for another doctor.

• Patients expect from a doctor not only high professionalism, but also sensitivity, directness and respect. According to modern concepts of medical ethics, patients have a right to such treatment.
• There are rules for the ideal doctor-patient interaction: The Calgary-Cambridge Model of Medical Consultation. The patient has the right to expect the doctor to follow this model when communicating with them.
• Not all doctors are good at communicating with patients.This does not mean that you have a bad doctor, but you do not have to endure unpleasant treatment with you. It is often enough to tell the doctor that you do not like something – most doctors do not even know what they are doing to you unpleasant.
• You can get the most out of your visit to your doctor if you ask the doctor why he asks you certain questions, what sources he relies on when prescribing your treatment, and ask him to answer additional questions.
• Do not hesitate to discuss the cost of treatment with your doctor.The doctor wants to help you, so he is interested in finding a treatment that will not only help, but will also be affordable for you.

What questions you shouldn’t ask your doctor

When visiting a doctor, people, of course, want to know everything about their diagnosis, methods of treatment and the most likely outcome of the disease. However, some questions can be confusing, confusing, or unsettling even for the most experienced practitioner. What is better not to ask doctors at all?

Tell me, will I die?

This question does not seem entirely correct.No one can live forever, so the doctor understands that each of his patients will die sooner or later. True, it is not known whether it is from the ailment he is suffering from now, or from another illness, or maybe as a result of an accident.

If you ask a specialist the same question, but at the same time specify whether you will die from the current diagnosis, do you have a chance to get an honest answer? In most cases, yes. After all, every adult patient has the right to know about his state of health.Another thing is that it is not always possible to give an accurate prognosis, even if you are well versed in the specifics of the disease.

At the same time, it is important to understand that in really difficult cases, doctors sometimes deliberately do not tell patients about the lack of prospects for recovery. And, believe me, they do it with the best intentions. After all, not all people, having heard that their illness can lead to death, are able to continue to fight the disease and still recover – this requires mental strength, determination and hope.

Many patients, having learned the truth, give up and refuse treatment even when they have a good chance of recovery.It is for this reason that doctors prefer to cheer up even the most difficult patients. Any doctor knows that sometimes miracles happen and even those patients who seemed hopeless get better.

In some situations, it is simply stupid to ask about a possible death: for example, if you came to the doctor with a mild cold. In this case, such a question will sound like an inappropriate joke or as evidence of inadequacy. This can even offend the doctor, who decides that you do not trust him so much that you doubt whether you will survive after his treatment.

Doctor, will I get well for sure?

In some cases, even the most experienced specialist will find it difficult to answer this question. After all, a doctor is not a magician, he is not able to heal absolutely all of his patients. It can be difficult to predict the outcome of a disease. Sometimes the simplest ailments can be accompanied by complications, and serious illnesses can end with complete healing.

A doctor can judge the prognosis of a disease only on the basis of his experience, knowledge and already available medical statistics, but no doctor is able to say in advance with certainty whether the patient will be cured.And even more so to give a guarantee.

Will this medicine definitely help me?

If a doctor has prescribed a medicine, he is sure that the medicine will help the patient. And only if something goes wrong in the course of treatment, for example, the medicine will give strong side effects or the patient suddenly has an allergy, then the doctor will decide to replace the drug.

Before asking such a question, you need to understand that the body is different for all people, and the drug that has helped to cure many other patients may be useless for you.Not because the doctor prescribed the wrong treatment, but because your body refuses to accept the therapy.

The doctor, most likely, will explain to you for what reasons he prescribed this or that medicine, how effective it is in his opinion. If, after that, you continue to demand guarantees of recovery, then you can offend a specialist.

You know how it is treated – why tests?

If the doctor has appointed you a second appointment, because the test results are not yet ready, or insists on an additional examination, then you should not refuse.The more procedures are performed, the more accurate the doctor will diagnose.

When a specialist at the very first consultation prescribes treatment without really understanding the clinical picture, this does not mean high professionalism and many years of experience, but about arrogance and irresponsibility. A conscientious doctor will not like it if, even before receiving the test results, you ask him how your illness is being treated. He knows how to treat your disease and many other ailments, just not yet sure of the diagnosis.

Questions not in the specialty

Some people believe that doctors must know literally everything about medicine. And even when they come to see an ophthalmologist, they ask why their back hurts, for example, or ask them to comment on the treatment of sciatica prescribed by another doctor. This is highly unethical.

In fact, doctors specialize in one thing for a reason. This does not mean that they know little about medicine. It’s just that each area of ​​this science is very extensive and requires a long study.For the same reason, one should not ask about the diagnosis and treatment methods of radiologists, ultrasound specialists or laboratory technicians.

The patient has the right to find out from health workers any information about his disease, methods of its treatment and its probable prognosis, but there are questions that are difficult to answer, keeping calm, so it is better not to ask them.

How to communicate with a doctor in order to be cured

_{Doctors ask questions all the time, patients are embarrassed to ask, there is not much time for an appointment, and someone constantly looks into the office.There are problems in the communication between a doctor and a patient: for a long time, doctors were not taught this, and people simply do not know how and what to ask.}

_{How to communicate with a doctor to get answers and the right treatment, says Anna Simakova, managing partner of the Three Sisters rehabilitation clinic, a communication and customer service specialist.}

_{People feel uncomfortable at the doctor’s appointment: they worry, get lost, forget what they wanted to talk about.They have to share intimate things about themselves, and the time is limited, and the doctor does not look at the patient, but does something all the time.}

_{In an ideal world, the doctor should make sure that the patient is comfortable, but if he did not, the patient can take care of himself. Here’s what he can do with an example:}

_{Do not go straight to the examination, but sit next to the doctor and talk. A person comes to the dentist, and he is immediately seated in a chair and asked to open his mouth.He has not yet had time to say why he came, but is already sitting in an armchair and muttering, because they ask him questions, but cannot answer with an open mouth. The doctor is responsible for it, and the patient, in saliva, tries to insert something.}

_{Or a woman comes to a gynecologist, and she is immediately put in a gynecological chair. Or in hospitals, during a round, the doctor comes to the bed, he has a few minutes, so he hangs over the patient, and she sits or lies, tries to throw her head back to look at the doctor, she is uncomfortable, it seems that the doctor needs to run, so it’s not the time talk about yourself.Meanwhile, the patient has some serious problems, but she is silent.}

_{In all three cases, the doctors want to get down to business right away, but this does not help the patients: they hoped that they would first share their concerns, thought over their speech in advance, but in the end they cannot say anything, they are angry with themselves and the doctor, they ignore the prescriptions, and the problems get worse.}

_{Therefore, it is normal to go to the doctor’s office and not go straight to the couch, to the gynecological or dental chair, but to sit nearby and tell what is bothering you.If the doctor asks you to go straight for an examination, answer that you would like to talk a little first:}

Three main questions to ask your doctor

Even hard knowledge is better than unknown

– When did you first encounter medical ethics?

– In residency, when I saw patients with amyotrophic lateral sclerosis (ALS) and began to wonder how to build relationships with them.ALS is an indicative diagnosis in this sense. The doctor knows that this is a serious, incurable disease; for several years, the disease deprives a person of the ability to move and communicate independently.

I noticed that the patients are not given the diagnosis and the essence of the disease is not explained. That is, they say: the disease is serious, let’s get treatment, let’s see. When I asked my senior colleagues, they told me: well, yes, it is not accepted, we do not speak. Because it can put a person into stress, he will feel bad, and we still can’t do anything.

But when you observe a patient until the last day, then at some point you tell him, and for some it brings relief: finally, they said something definite.

You already understand – even heavy knowledge is better than the unknown.

You read patient stories in books: people with ALS write that they are grateful to the specialists who told them the diagnosis. A person can do a lot before he can no longer move. There are many charitable projects in the world that are founded by people with ALS, one of them is an international study of the genetics of the disease.

When you collect all this, you understand that ethical issues are especially acute when it comes to life and death, and that there is no unambiguity. The biggest problem is that most of us don’t even see where ethics are violated.

For example, I can only now say that by hiding the diagnosis, we violate the basic principle of bioethics – patient autonomy, that is, the freedom to make decisions about ourselves and our health.

In our ALS care team, we have come to formulate and resolve ethical issues through multidisciplinary discussion of each patient, through analysis of international experience and through communication with patients and their families.

Three main questions to ask your doctor

– How can the patients themselves influence the communication with the doctor, what is their responsibility?

– I think the patient’s role is underestimated. Many people will shower me with tomatoes, but in real life patients often do not understand what you are telling them. Therefore, it is important to disseminate information among patients on how to communicate with the doctor.

There are three main questions that the patient should ask the doctor: 1) what is wrong with me? 2) What can I do to make me feel better? 3) What do I need to know to do this?

A person himself must want to find out and understand.Most leave the hospital without following the guidelines they are given upon discharge. The doctor is rarely asked what is written there, and he has no motivation to explain. It turns out a vicious circle that needs to be broken. Therefore, it is necessary to promote a conscious attitude of patients to treatment.

– Recently there was a scandal with a Moscow clinic that offered female circumcision for religious reasons …

– Yes, the medical community has to get involved here.Everything should be done for medical reasons. If there are no such indications, then the doctor should not follow the lead of the patient or his relatives. There are a million times when a patient asks for something that you cannot do. People, for example, regularly ask for plasmapheresis. What for? “I read that this is a good procedure, I will pay you.” No, doctors provide assistance only if there is a medical indication.

– But does plastic surgery exist without a medical indication?

– She also has her own protocols.Plastic surgery is broader than improving an already perfect appearance.

– They say that now many patients do not leave the doctor alone even after work and ask questions in instant messengers?

– Yes, but if a doctor sees a person in front of him who really wants to deal with the prescriptions, then there are fewer problems with him and less time is spent on such a patient.

– Can a doctor receive gifts from a patient?

– Maybe. This is gratitude.But gifts should not be a condition for helping.

Human Experiments and Ethics

– When did they stop hiding information about the disease from patients at all? Cancer was never reported before, was it? Is it somehow connected with the fact that cancer is better treated?

– Articulating ethical principles has certainly helped. For example, in the United States, public attitudes about the importance of a truthful and open relationship between patient and doctor have changed dramatically since the infamous medical study of syphilis in the city of Tuskegee.(In 1932, the Public Health Service began investigating the various stages of syphilis – 600 African Americans, from the poorest townspeople, participated in the experiment. In the forties, syphilis was successfully treated with penicillin, but doctors hid this fact from the participants and continued the study – as a result, many of them died from syphilis, many infected their wives, and children in such families were born with congenital syphilis.In 1972, journalists published an investigation and the experiment was stopped – approx.ed). It was a very high-profile case, ethical principles in medicine began to be discussed at the level of the US government and a number of documents were adopted based on the principles of bioethics and regulating research with human participation.

– Does patient information relate to the principle of autonomy discussed in the course at Inliberty?

– Yes, this is respect for the patient’s choice, for his desire to know or not to know.

– The Russian Medical Code, the Hippocratic Oath, suggests that the doctor is obliged to inform the patient?

– Our pure ethical standards do not exist at all.In the West, the professional community is the guardian of ethical norms. For violation of ethical standards, the professional community can remove a doctor from work. This is not civil, not criminal liability, not a court, not a prosecutor – this is an association. We have many codes, but no one enforces them. The Hippocratic Oath is written within the law of the Russian Federation, and everything in the law is written in such a way that it does not answer any ethical question.

– Can medical education and the medical scientific community influence the development of common ethical standards?

– Education can improve the situation, of course.You can and should teach. But then everything depends on why I will do it? If I lie to a patient, prescribe treatment that does not work, and humiliate my colleagues who treated him in the presence of him – what will it be for me? Usually doctors discuss with colleagues only medical applied aspects: appointments, diagnoses. Ethical issues are rarely discussed – there is no time for this, and there are no mechanisms to implement the results of these discussions.

There are no definite answers, but there is a choice – then you burn out less and there is less guilt

– Who is developing medical ethics in Russia today? Are there specialists in this field and how do they work?

– There are initiatives from different sides, but so far they have not been implemented in any way.Many talk about the creation of an independent medical association, but no one is ready to take on this great work on their own. There are private clinics where internal codes of ethics are adopted, but this is not a common practice. Why I took a course on medical ethics for doctors at Inliberty: every doctor every day faces questions – how to talk about side effects, stop treating a seriously ill person or not. A safe space is needed to discuss these situations and how to get out of them.

– Will the Physician-Patient Affiliate Scheme solve these problems?

– Affiliate model is time consuming. Sounds good, but in practice, many patients prefer doctors who do not discuss treatment with them (paternalistic model – ed.). When the doctor confidently says: do so, the patients are calm. Ethics discusses these issues and shows two main models of ethical decision making: deontological and utilitarian.

If you think about principles and define for yourself that your principle is to discuss the diagnosis with the patient and do everything together, then this is more likely deontology.And utilitarianism is when you focus on the end result, make a decision in order to increase the likelihood of a favorable result. Two systems, each of which gives its own answer. And none is the only true one. But if you are aware of which system you follow, then you burn out less and feel less guilty if something happens. For example, you discussed with the patient the diagnosis and possible solutions, and the person refused help or went and committed suicide. And then, in order not to go crazy, you say: I did everything right, but it happens.

Patient with “Do not resuscitate” tattoo

– The course showed a circle – an algorithm for making an ethical decision: the doctor correlates his moral intuition with the principles of autonomy, harmlessness. What is this circle?

– Yes, you go through this circle within yourself until you reach inner balance. Your inner balance is the criterion for the correctness of your actions. This principle is closer to the system of deontology. Although you can use in this circle and a utilitarian system – the assessment of consequences.But all the same you are guided by the inner state.

There is also a method – you evaluate your work by the patient’s reaction. In the first scheme, you create an ethics committee in the clinic and go there with a problem: for example, a patient has been admitted with a “do not reanimate” tattoo, what are we going to do? And the committee tells you. There are such options. And if you follow the second path, then you need to create a department for evaluating the patient’s experience – there are also such departments in Western clinics. The patient is a measure of the correctness of what you are doing, his impressions of the hospital, of the treatment: here he waited too long, here he was in pain, then he was upset that his mother was not allowed to see him.It turns out that some doctor’s patients are constantly unhappy, what’s the matter?

We will not create an independent medical community right now – this is a matter for many decades. But something can be done within individual clinics: create ethical committees or a system for evaluating patient experience.

Another important thing that became clear: many believe that medical ethics and communication (the ability to communicate) are one and the same. I’m sure it’s not. Knowing how to tell a patient about a bad diagnosis is not the same as deciding to do it.The decision to go downhill and the ability to ski are two different things.

– Isn’t the ability to speak well with a patient an obligatory professional quality of a doctor?

– We often have neither one nor the other. Speaking is an important skill, but it is not taught in universities.

– What is the correct way to report an unpleasant diagnosis?

– I am not a specialist in communication skills, now there is an excellent monograph “Communication skills with patients”, authors Silverman, Kertz and Draper – highly recommend.

Photo: Pavel Smertin

Cancer that will never happen

90,000 7 Signs Your Doctor Is Being Unethical – Wonderzine

If we go to the doctor in order to resolve the issue of hormonal contraception, and we are offered to have a child instead, or we come with a splinter in our finger, and the doctor advises us to reduce body weight, this is an eloquent, frank and unacceptable violation of rules. Even if a doctor has his own ideas about life, he should not express anything other than the real provisions of evidence-based medicine. And then only in response to a direct question.

Of course, to a person without medical education, some questions may seem irrelevant or to the main specialty of a doctor, and sometimes even tactless. Although in fact they are quite normal: the doctor must take into account everything to the smallest detail and pay attention to details that are not necessarily obviously related to the patient’s complaints.It happens that patients and patients are confused by issues related to weight, menstruation, pregnancy and abortion, sex life. This is due to the fear that they are not “the norm”, or because of the indelicacy of the doctors with whom they had to deal with before.

The doctor can ask us questions about the state of health, habits and lifestyle, history of the development of symptoms, concomitant diseases and medications that we take, ask about cases of diseases among the closest relatives: parents, grandparents, siblings.These many questions should be treated with patience and understanding.

However, this does not mean at all that absolutely any question will be acceptable. If you have the feeling that the doctor is outside the scope of your request, you need to indicate this. After all, it may turn out that tactless questions are asked simply out of curiosity. For example, intersex people and trans * people are often asked about the structure of their external genitals or the details of their sexual life.

The same applies to recommendations: they should be based on our request.If the doctor does not offer solutions to the problem with which you came to him, or persistently suggests that you deal with the issue that does not bother you, he is violating your boundaries.

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