Why don’t patients ask Doctors more questions?

Stephen Wilkins over at Mind the Gap has written a post summing up 5 major reasons why patients don’t ask more questions of Doctors:

Fear – fear of what the doctor may think of them, fear of what the doctor may say, fear of looking or sounding stupid in front of the doctor, fear of getting the wrong answer.
The Doctor Knows Best – if something is important the doctor will mention it, if I need the test the doctor will order it, and so on.
Not wanting to interrupt – office visits follow a clear pattern opening statement, medical interview and exam, diagnosis, treatment and closing. Other than during their opening statement, most patients realize that the doctor does most of the talking.
Not being asked by the doctor if they have any questions – studies show that physicians do not ask patients if they have any questions in more than 50% of office visits.
Patient feels rushed – feeling that their question isn’t really all that important after all.

As I always like it when others share their ideas on how to improve the patient experience I thought it would be a useful exercise to list here how at 3G Doctor we’ve designed our service to help our Doctors offer better care and ensure patients get the opportunity to ask questions:

1 Fear

By providing patients a private means of communicating with a registered Doctor (eg. we don’t prescribe, sell anything or run tests etc) it keeps us focused on listening, talking, documenting the encounter and the overall patient experience.

The use of an online interactive medical history questionnaire prior to the consultation also helps ensure patients give answers to all of the relevant questions – and the evidence shows that patients are more honest and find this to be an easier way to reveal their symptoms than in a face to face encounter – especially when the patient may consider the issues to be embarrassing.

2 The Doctor Knows Best

I think it’s safe to say that we’ve fully accepted that the patient knows best and that we need to listen to them. I know it’s easy to say such seemingly lofty things but evidence for our commitment to this can be found by looking at how we’ve designed the service to listen and document everything our patients want to share with us before the 3G Mobile Video Consultation with the informed Doctor.

The production of a written consultation report from the Doctor after every consultation is evidence of our trust in the ability that our patients have to manage their own information.

3 Not wanting to interrupt

The use of an advanced interactive medical questionnaire and free text box prior to the consultation means that this issue is practically avoided because our Doctors are consulting in a much more informed capacity. Because all the routine and basic questions have been asked the Doctors can spend much more time with any remaining questions the patient may want to ask.

The feedback process we have ensures Doctors who notice questions that should have probably been asked of the patient we can have these added so that in the knowledge/design contained within our questionnaire databases is continually improved and made more effective. For more on this please join us at the Royal Society of Medicine on the 20th Sept 2010.

NOTE: Some people testing the service (who didn’t appreciating that the questionnaire was interactive) have ended up complaining that there were too many questions because they kept selecting random “Yes” answers to questions that are designed to rule out whether the patient had any particular medical history. This isn’t a problem with “real patients” as (except for those with certain psychological conditions) they obviously wouldn’t feel to need to select that they had a heart condition if they’d never had one!

4 Not being asked by the doctor if they have any questions

When patients request a consultation with 3G Doctor, after ensuring that the patient isn’t in need of urgent care (in which case we request they contact emergency services) and are located in the UK/Ireland (for medicolegal reasons), the first thing we do is ask them what they would like to consult with a Doctor about. The patient then selects answers to a relevant set of interactive questions about their health and how they’re feeling.

After this there is a free text box in which the patient can detail any other things they’d like to share with their Doctor.

By using this process instead of “only 50% of patients being asked questions”, each and every patient is can be asked all the relevant questions and even feel welcome to ask as many of their own…

5 Patient feels rushed

I think on this one the 3G video mobile really helps us differentiate the service from conventional in-office consultations. There’s no time and place like your own and with anywhere anytime access and availability combined with a service that doesn’t rush a patient when giving their history I think it’s safe to say we’ve got this patient issue beaten.

With the written report documenting each and every consultation we also help patients relax during the consultation safe in the knowledge that the advice, recommendations, URL links etc that the Doctor may share don’t need to be written down as they’ll all be documented alongside the Doctors notes when they next log in to view their consultation report.

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