[tweetmeme source=”Healthmessaging” only_single=false]A neighbor of mine was diagnosed with breast cancer about the same time was wife was being treated for lung cancer. I saw my neighbor the other day for the first time in several years. I asked her how she was doing. She said great. In turn I asked her how her PET/CT exam looked. PET/CT scans are often done to make sure that one’s cancer hasn’t spread. My wife gets one every year. My neighbor told me her doctor never told her she needed one…that mammograms would suffice. She went on to say a friend had also recently asked her if she had a PET/CT as well. “Maybe I should ask my doctor” she told me. That was the same response she gave me the last time I raised the subject two years earlier, “I should ask my doctor.”
So Why Don’t People Ask More Questions?
My neighbor is not alone when it comes to asking their doctor questions. In an earlier post, I cited research which found that patients ask their doctor an average of 2 important questions during the office visit.
According to researchers, there are five reasons why people don’t ask their doctor questions. These reasons include:
- 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.
In my neighbor’s case, I suspect that “fear of knowing” the results of a PET/CT scan may be the overriding reason why she has not asked her doctor about having the exam. Why invite bad news if you don’t need to. Fear is a pretty strong motivator. Strong enough in many instances to trump another strong motivator – one’s survival instinct.
Check out Why Patients Don’t Ask More Questions Part 2
If You Have A Question Write It Down And Give It To Your Doctor
One way for patients to ask their doctor questions is to write them down before the visit and give them to the doctor at the start of the visit. That way patients can avoid having to worry about how or when to ask a question. Physicians for their part should invite patient questions even at the risk of extending the office visit.
Sources:
Roter, D. L. Patient Question Asking in Physician- Patient Interaction. Health Psychology. 1984; 3 (5) 395-409.
Cegala, D. Personal notes. 3/12/2010.
Mind The Gap 
I remember having a science teacher you used to ask, write before a test, if anyone had any questions. But that throwaway offer was useless for those of us who so lost in the subject matter, we didn’t even know what kind of questions to ask. Merely offering a throwaway Q & A session may not result in asked questions if the patient isn’t sure what questions he or she should ask. A more nuanced invitation might work better.
Michelle,
Absent certain other patient factors, you are right. Simply having the physician simple ask if the patient has any questions is not enough. What it does accomplish however (according to the research) is send the signal to the patient that the provider is interested in what the patient might have to say. The problem with provider taking this approach is that they really need to “walk the talk.” That is, when the patient eventually does ask a question, the providers can’t “brush the patient’s question off.” They really need to answer the patient.
That’s the amazing thing about communications science. It doesn’t take much to make a huge difference in patient perceptions..and eventually patient satisfaction.
Yes..they really need to answer the patient. The last time I tried to ask my GP a question I got
1. an answer I suspected to be wrong based on my own research (and which indeed turned out to be wrong)
2. the brush -off when I asked some procedural questions about what would happen next.
I left feeling really angry and ill-served. Now why I don’t just change my doctor, I’m not sure.
Patient-doctor communications is a tough subject. I always tell my clients to remember one statement “The doctor works for you.” Just as you wouldn’t allow an employee to brush you off, you shouldn’t allow your doctor to do so either. If he doesn’t respond to statements like “I’m sorry, I don’t understand, can you explain a bit more? or “How does that work with (fill in the blank with whatever you’re confused about)?” it’s definitely time to look for another doctor. There are a lot of good doctors out there and you’re doing yourself a disservice if you stick with one who won’t work with you and answer your questions.
Had your neighbor ask her doctor about her CT/PET scan for breast cancer she could tell you that most Oncologists don’t routinely scan breast cancer patients post-treatment unless there is some indication the cancer has returned.
You are probably right…which is counter intuitive given that by the time a recurrence is detected, it may have spread. At least that is the logic used with respect to my wife’s follow up with Lung Cancer.
My doctor doesn’t order regular scans because he feels they are supercilious and mostly unneeded. If I go into his office and complain of a head ache or a painful bone, he is the first to insist on a scan. He feels that a scan without a reason to ask for it puts me in risk of further exposure to side effects of radiation.
Stephen, insightful article, as always. As you know, Physicians are under increased pressure to “keep the conversation short and factual” to increase productivity tied to their RVU’s. However, they don’t realize (on the surface) that if they sit, it relaxes the patient, lowering their blood pressure. When they solicit questions from the patient, it builds trust, and trust leads to compliance (like filling meds and follow through on prescribed treatment), and the patient’s treatment compliance means the likelihood of re-admissions goes down, which we don’t get paid for anymore. Now, if we can just get MD’s to take their hand off the door knob when they ask, “Do you have any other questions? I have the time.”