Coaching For Doctor Office Visits Helps Patients Ask Right Questions

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Coaching For Doctor Office Visits Helps Patients Ask Right Questions

Asking more questions during a visit to the doctor might help

patients get care that is more satisfactory, but many patients are

not sure where to start.

http://www.sciencedaily.com/releases/2007/07/070719130634.htm

A new review of 33 studies found that giving patients question

checklists or providing in-office coaching can help them ask more

questions of their health care provider and get more information

that is useful -- often extending the length of the consultation as

well.

" For outcomes like satisfaction, the patient's response is likely to

cover the whole experience in the clinic -- coaching and

consultation -- and thus the patients will feel like they got a

better deal than usual as they had a nice time with the coach, " said

lead review author Kinnersley.

The review appears in The Cochrane Library, a publication of The

Cochrane Collaboration, an organization that evaluates medical

research. Systematic reviews draw evidence-based conclusions about

medical practice after considering both the content and quality of

existing medical trials on a topic.

When interventions took place immediately before a consultation,

they resulted in a small but significant increase in the duration of

the office visit. Interventions that occurred some time before the

consultation had no effect.

In general, interventions produced small increases in patient

satisfaction, plus a possible reduction in patient anxiety before

and after visits. Coaching had a slightly larger benefit in patient

satisfaction than providing question checklists.

" Coaching is a more intensive intervention and may have some

therapeutic impact, " said Kinnersley, co-director of the

Communications Skills Unit at Cardiff University in Wales.

At the very least, coaching helps patients voice and rehearse their

concerns.

" Patients need to have the courage and confidence to ask questions, "

said Sherrie Kaplan, Ph.D., co-director of the Center for Health

Policy at the University of California, Irvine. " Many patients don't

want to look stupid. Studies have shown that even doctors find that

when they are patients, they don't want to ask questions that will

make them look stupid. "

The review also looked at the value of refresher courses in

communication skills for doctors.

Doctors can underestimate their patients' information needs for a

variety of reasons, according to the review authors. When treating

patients with serious or life-threatening illnesses, doctors might

be reluctant to dispense information that they feel could be harmful

or disturbing. Alternatively, they sometimes focus so hard on

confirming a diagnosis that they do not take the time to encourage

patient involvement in constructing more individualized treatment

approaches.

" Doctors are prepared to ask questions, to formulate what's wrong,

find it and fix it, " Kaplan said. " In studies we've done, the

patient will talk for about 30 seconds before the doctor interrupts

with more questions and takes over. " Kaplan was not involved with

the Cochrane review.

According to Kinnersley, doctors do benefit from refresher courses

in communication, even if they are not always eager to go.

" Pretty much every medical school will teach communication skills

and assess them before qualification, but we still have evidence

that patients are dissatisfied with doctors' communication skills, "

Kinnersley said. " I think the problem is that after qualification,

doctors learn a lot more clinical knowledge and they get more

enveloped by medical culture. Thus, their communication skills often

deteriorate. They focus on curing the patient rather than caring for

them. "

The review found small increases in consultation time when doctors

received training, but found no significant increase in patient

satisfaction. Ultimately, the review recommended more studies to

compare methods of intervention, intervention timing and the

possible benefits of additional training for health care providers.

The review studies covered a variety of settings and diagnoses,

including primary care, cancer, diabetes, women's issues, heart

problems, peptic ulcers and mental illness. It is possible that the

more serious the illness, the greater the level of anxiety might be

and the more intimidated a patient will feel about asking questions,

Kinnersley suggested.

" If patients are anxious or the answer to a question might be

frightening, you're going to need more encouragement to ask

questions, " he said.

For Kaplan, the key to getting the most out of any doctor visit and

reducing anxiety is preparation. She compares preparing for a doctor

visit to studying for a test.

" Anxiety can affect your memory but if you haven't prepared to take

a test, whether you're anxious or not, you are not going to do

well, " said Kaplan. " You need to prepare so you can be cool, calm

and collected. Patients need to meet the doctor halfway and doctors

need to give patients the sense that there is some way they can get

involved in their own treatment. "

Reference: Kinnersley P, et al. Interventions before consultation

for helping patients address their intervention needs (Review).

Cochrane Database of Systematic Reviews 2007, Issue 3.

Note: This story has been adapted from a news release issued by

Center for the Advancement of Health.