Patient questions during doctor visits are uncommon

Ask your doctor. I think most of us would agree that is good advice, at least up to the point that we find ourselves sitting half naked on an exam table in our doctor’s office. Then the doctor walks in and for some reason many of us just “clam up.”

Patient question-asking during the primary care office visit was and continues to be an “index” of patient health information seeking behavior. Since the first of such studies going back to the late 1970s, researchers have found that, except for patients who are highly involved in their own health care, most people ask their doctor few if any important health questions.

Here’s an example of what I am talking about.

At face value, one would think that being “put on a new medication” would prompt patients to ask their doctor a few questions. Why do I need this medication? What are the side effects? How should I take it? What about other medications I am taking? When can I stop taking it?

If you think that way, you would be wrong.

By way of evidence, I cite a 2008 study in which 181 patients were prescribed a new medication by their primary care physician or a cardiologist during an office visit. In total, patients initiated 199 questions or comments (1.09 per patient) based upon a coding of audio tapes of each patient visit. Table 1 shows a breakdown of the frequency of patient questions by type and duration of patient talk time (in seconds) associated with each question topic.

Patient questions during doctor visits are uncommon

Of those patients that did ask questions, the focus was on the important questions — how to take the medication, side effects, and the purpose of taking the medication. The brief amount of “patient time” spent on these important topics was compensated for during physician talk time, e.g., physicians spoke for 10 seconds on the purpose of the Rx and 8.25 seconds on how to take the medication. Keep in mind that physician talk time for all physician comments related to “starting a new medication” was less than a minute for the entire visit.

These findings may seem very counter intuitive given all the reports of coming out of the Pew Research and other survey research about patients “wanting more health information.” There are after all at least 500 pages listed on Google of health websites recommending “questions to ask your doctor.” But according to many studies on the subject, what people say they want (more health information) and what they actual do (engage in question-asking behavior) can be and usually is very different.

The low level of question-asking behavior exhibited by patients in the small study cited above study is not an isolated finding. According to Donald Cegala, PhD, Professor Emeritus of Communication and Family Medicine at Ohio State, who has written extensively on this subject, “the literature and my research experience suggests that most patients do not ask any questions, and those that do average about 2 questions (per visit). ”

So what are the factors that explain why so few patients actively engage in question-asking? Are there strategies for getting patients more engaged in addressing this interesting challenge?

Stay tuned. I will be elaborating on these questions in future posts.

Steve Wilkins is a former hospital executive and consumer health behavior researcher who blogs at Mind The Gap.

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  • Trious

    As a patient, I tend to ask some questions but probably not as many as I should

    I guess there are times when I clam up because I just assume that the doctor knows me and knows what I need so who am I to act like I am questioning his decision?

    That may sound a bit odd but many doctors I have seen do in fact get inpatient when a patient questions or just asks a question after he has said something

  • family practitioner

    What are you talking about?
    Most patients have a long list of questions.

  • http://butdoctorihatepink.blogspot.com Ann

    I may be unusual, but as a patient I don’t ask a lot of questions because I typically know what the doctor is going to say and prescribe ahead of time. I’ve done my research. As an example, before I started chemo, I knew the likely combination I’d be taking, and I researched it completely. There are a lot of legitimate places online to get information. So, when I was told I really had no questions. I can’t think of a single instance where I went to a doctor and didn’t already know what was wrong with me and the common treatment for it. I haven’t been surprised yet.

    However, I do think that many people are afraid to take up a physician’s time, and people are good at reading body language. Many PCPs don’t have time to spend and people know it. The physician who posted above – that his patients have long lists of questions – probably exudes concern and his patients know he’ll take the time to answer. Not all do that.

    I just found this site, will be browsing a lot!

  • minutemoon

    So — let me understand this — the patient is sitting naked on the exam table and then for some reason many just just “clam up.” Now why would that be? For “some” reason? Could one reason be that one person is dressed and the other is naked? One person is on home turf and the other is in a strange setting? One person is in a power position and the other is not? The psychosocial dynamics of nakedness and nudity is rarely taught enough in medical schools; then, once in hospitals, doctors absorb the hidden curriculum and eventually don’t even “see” nudity anymore. They become routinized. And many young doctors, in relative good health, have never experienced the vulnerability of being naked under gown, waiting for an especially invasive, intimate exam or procedure. Perhaps the time of questions shouldn’t be when the doctor is dressed and the patient is naked. Perhaps that time should be after the exam when the patient is made to feel more comfortable, dressed in his or her own clothes, sitting face to face with the doctor in a more relaxed, less clinical environment. Of course, much depends upon the personal relationship between physician and patient. Some patients may feel more comfortable with their doctors than others. But others never really feel at ease in the situation I’ve described above.

  • http://www.eleventhhourllc.com LauraNP

    It’s hard to feel comfortable asking a question when the doctor has his hand on the door knob ready to leave and he tells you how busy he is!

  • soaringcanary

    In my experience as the health advocate and daughter of three parents as well as other relatives in their 90′s, I have not only had a list of pertinent [cut to the chase] questions for the MD but so have I taken notes while all of us were clothed and in general, there have been two reactions from a myriad of Family Practice and other MD specialties. Specifically, the first relates to how they initially welcome my interest and presence and yet, once the in-depth discussion ensues….I can see by their closed body language and changed facial expression that they are no longer listening or professionally available to any of us. Secondly, as some have sought to justify by saying they didn’t have enough time [typical 12 minute allotment does negate more in-depth analysis] there was one who, after we had been listening to his defensive tirade…finally reached his maximum tolerance by turning to the folks to ask that they not bring me in with them again. So, does anyone think these examples of ‘defensiveness’ [when I told all upfront that I was eager for their expertise for sake of the Team [family/provider] effort]…would be encouraging to my family members or so many others like them who walk in through those clinic doors feeling intimidated by the officious nature of such ‘white coat authority?’ Of course not. So, until the mainstream medical delivery system — with such disrespectful and inferior interface between human beings — can do a 180 I say every patient NEEDS their own advocate to be the intermediary representative who is more likely to have ‘their’ best interests at-heart. Tragically, since insurance corporations now drive their businesses, there are few MD’s [in area where I live] who insist on having a meaningful connection with their patient…by demonstrating their genuine empathy in what used to be called “a good bedside manner.” Lest you wonder, this concerned daughter felt it imperative to get involved only AFTER all of these elderly people had been put on powerful pharmaceuticals which, over time, had incited their own harm. In my opinion, no man, woman, or child should be put on these foreign to the body/synthetic chemicals ‘for the indefinite long term’ and yet, these days with an average of 7-9 medications per patient, this is exactly what’s happening to millions of Americans…and especially the frail and “unquestioningly compliant” elderly. Needless to say, with such lack of personalized or more in-depth analysis while looking for cause…and rather, as there is far too much pill pushing to mask symptoms, this is in no way related to a respectful reciprocity between the provider and patient and worse, neither is it akin to an honest delivery of true ‘health’ CARE.