Patients often feel overwhelmed and intimidated when they attend hospitals and clinics. These are busy places, time can be tight and, as professionals, we can unwittingly send out signals that might prevent patients from engaging. Unsurprising then that on many occasions patients say little and ask few questions. An unpublished American study showed that from the time they arrive until they leave, men ask an average 1.4 questions, including asking about parking!
This post is about questions, using them to encourage patient’s to actively engage in their healthcare and things we could ask to help shine a light on the complex mix of physical and psychological issues accompany illness.
This topic is particularly close to home for me. My elderly mother has recently attended outpatient clinics in Edinburgh where she felt unable to ask questions during her appointments and was left no clearer about her condition. What’s more, because some questions were overlooked the professionals involved had a very sketchy picture of what was happening to her and this affected the success of treatment.
In Clinical Psychology we tend to start asking questions at the beginning of a consultation so the patient can understand why they are there and what to expect from the appointment. This includes setting the agenda, a practice that could have value in other clinical settings as it ensures we have common goals for the available time and promotes collaboration (and involved patients tend to have better outcomes, Redding, 2017)
To set the set the agenda and make constructive use of time we might ask questions such as:
- What would you like to get from this appointment?
- Why have you come along today?
- What would be helpful to you today?
- This is why I think you are here and this is what we need to do, are there any questions before we begin?
I couldn’t attend appointments with my mother so we set her agenda by writing an outline statement of her problem giving clear information about her condition. This approach proved to be a great help to the outpatient clinic, helping them to understand her problem more clearly and how it manifested day to day, helping her achieve better outcomes.
Patients in clinics may have many questions about their treatment that are primarily used to gather information: what is this test for? When will I get the results? How do you spell the name of that drug? Can I park in the ambulance bays? We may ask similar closed questions in the course of a consultation like “is this the worst it’s been in the past month?” Using closed questions are useful when we want factual information and can create opportunities to ask open questions or invite a broader reply like “can you tell me a bit more about that?”
My mother was attending outpatient appointments to address poor mobility caused by an arthritic condition. During the appointments she was examined, her medication checked and the appointment would end with something they hoped was helpful. Questions about how she was feeling, what she thought and how her behaviour had changed were overlooked. If they had been asked they would have realised she felt a bit low and useless, had thoughts like “nothing is working so what’s the point” and her behaviour had changed; she went out less and stopped enjoying life. This all affected her condition which continued to deteriorate.
When patients are suffering from a health problem they can experience a whole range of unhelpful emotions that could affect their treatment. These emotions can be grouped under three headings.
- Loss: sadness, down, and depressed.
- Fear: anxiety, panic and terror.
- Anger: rage, frustration or irritation.
Emotions can lead to unhelpful thoughts about health that can often be untrue. Feelings and thoughts can lead to behaviour changes the patient makes often with the intent of helping matters but in reality can have the opposite effect. So making small changes in our routine practice can help us become more familiar with our patient’s condition by understanding how it makes them think, feel, and act.
Involved patients have better outcomes. But if they are less likely to ask questions because of the environment, what open and psychologically-aware questions might we ask to help us have a better understanding of their problems?
What does that make you think?
What runs through your mind when that happens?
When you feel like that what does it make you think?
What images come to mind when that happens?
How does that make you feel?
How do you feel when that happens?
When you think that how do you feel?
What did you do when you thought that?
What did you do when that happened?
Is there anything you do that you find helpful / unhelpful?
When you feel that way do you notice any physical sensations?
Do you notice any physical changes when that happens?
Have you noticed any physical changes when you get those thoughts?
In psychological therapy it is important to invite people to make changes to their usual practice. So, with that in mind, which of the above questions will you commit to try at your next clinic?
Don Redding (2017) Patient engagement: A ‘win-win’ for people and services NHS England Publication.
Robert Barton is a Psychological Therapist with the Clinical Health Psychology service