Sophie Davis students teach patients to ask questions
12/28/2011, 6:11 p.m.
With some of his students, Deen is in the early stages of research to measure the efficacy of the patient activation intervention. "We want to know what goes on in the doctor's office in order to see whether the interventions seem coercive, whether patients behave differently and how doctors feel about it," he explained. "The latter is a major concern, since doctors don't have enough time and we want them to respond positively to patients' questions."
Preliminary findings suggest that the number of questions patients ask does not bother physicians.
"People think doctors don't have time for too many questions, but the reality is that the number of questions doesn't seem to influence the doctor's perspective," said Maryann Garcia, a fifth-year Sophie Davis student who spent last summer as a research assistant with Deen.
Garcia sat in on 120 patient/provider encounters at two clinics in Manhattan and the Bronx and recorded patient questions. She then debriefed the doctors on their patients' question-asking behavior to see whether the number of questions affected the provider's perspective on how engaged they thought the patient was and whether they asked too many or too few questions.
The findings were statistically significant but not clinically significant, she noted. Factors that impact the patient-doctor relationship, such as type of visit, previous relationship with patient and length of the relationship, were not accounted for. "The type of question a patient who has been with the same doctor for 10 years asks may not be the same as that posed by a new patient," said Garcia.
"People have difficulty controlling their health, but asking questions is a way to take control," said Joanna Fernandez, a classmate of Garcia's who shared the patient activation intervention as a Mayor's Health Literacy Fellow in 2010. "Patients felt it gave them a sense of empowerment."
However, people with limited education and English language skills may be too embarrassed to ask questions, Fernandez noted, adding that this problem was common among older and immigrant populations.
Garcia concurred. "Patient activation is not a magic bullet," she said. While asking questions is the ideal form of communication, some patients seek information by making statements.
"As a future physician, it's training me to be better at asking questions and helping me highlight to patients the importance of them asking me to do something," she said. "If they don't ask, they will leave unhappy with their questions unanswered."
"The goal is to change behavior for future visits," concluded Deen. "Changing the way patients interact with doctors is the brass ring for us."
For more information on the Right Question Institute, visit rightquestion.org.