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Senior Citizen Health & Medicine
Coaching for Doctor Office Visits Helps Patients Ask
Right Questions
Preparation also helps provide doctor helpful
information
By Joan Vos MacDonald, Health Behavior News Service
 July
19, 2007 - 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. 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 Paul Kinnersley.
The review appears in The Cochrane Library, a
publication of The Cochrane Collaboration, an international 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.
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Patients Also Need
to Prepare to Provide Information to the Doctor |
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A survey in 2003
found that only about one in three people visit doctors' offices armed
with information they've already gathered, while close to two in three
people seek out information after visiting their doctors.
"There is tremendous
value in preparing for a doctor's visit," Marie Savard, M.D., internist,
author and patient advocate based in Philadelphia, said in 2003.
"Studies show that
doctors base up to 80 percent of their diagnoses on what patients tell
them about their symptoms, history and lifestyle."
Preparing in advance
for a trip to the doctor helps a patient feel more confident in
articulating symptoms and raising issues or questions to the doctor,
particularly in situations in which the patient may not understand the
doctor's advice.
"My advice to all
patients is to be informed about your health," Dr. Savard said.
"The more you are
involved in your health care rather than relying solely on your doctor,
the healthier you could be.
Savard says her most
important tip for preparing well for a doctor's visit is to visit a web
site that contains health information from sources that doctors trust
and recommend.
"Patients have
access to credible, physician-trusted information and tools online. One
of the newest avenues to quality health and medical information is
MerckSource.com, which provides people with access to the types of
resources that can help them partner with their doctors in managing
their health," Savard said.
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“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.”
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