Taking the time to answer patient questions

I was working in the bone marrow transplant clinic of an internationally known cancer center.  When I looked into the patient’s faces,  I saw hope as they were being worked up for a possible transplant.

I went into see a new patient.  She had leukemia and had relapsed after her remission.  Her sister would be the donor.

Gretchen, age 19 came in with her mom for the appointment.  She was tall, youthful looking and had a twinkle in her eye.  Yet, I found  out, she rarely spoke.

I introduced myself and explained to Gretchen this appointment was to answer her  questions she would have regarding her upcoming bone marrow transplant.

“So what questions do you have Gretchen?” I asked her three different times.

Each time, Gretchen did the same thing, she looked at me, then at her mom, then at her mom’s purse, then back at me.  She didn’t say anything, nor did her mom.

“Hmm, I thought to myself, I certainly would have questions if I was looking at being admitted for a bone marrow transplant.”  So once more I asked Gretchen whether she had any questions, but this time I looked her straight in the eyes and said, “Gretchen I’m not going anywhere, I’m not going to leave this exam room until all of your questions have been answered.  So let’s start with your first one, what is it?”

Gretchen looked at her mother, and pointed to the purse.  Her mom lifted her purse, pulled out 2 sheets of paper and handed them to Gretchen, who handed them to me.

I opened the two folded sheets, tattered and worn, and realized answering all of her questions was going to take a long, long while.  I looked over her list of 30 questions and immediately realized that she had been carrying it around with her since she was first diagnosed with leukemia 18 months ago.  She had just been adding questions to her list ever since, because she wasn’t comfortable with asking anyone.

She had gone through a whole treatment program, with no one answering her  questions.  And yet she was willing to trust me with her treasured, worn list of questions.  I was honored.

As I thought back over the afternoon episode with Gretchen I realized something very important.  Gretchen was probably like a lot of patients we see in medicine.  We as providers get so busy and cram our clinic schedule so full that we don’t take the time, when it’s needed to answer our patient’s questions.  In so doing, we have done them a  disservice.  Patients are not comfortable enough to stop us and ask their questions.  We as providers don’t give them permission to ask their questions because we don’t portray the body language necessary for the patients to know they are important.

We as providers need to learn to communicate better, take the time to answer our patients questions, put our patients as ease, so they can acquire better health for themselves.

Sharon Bahrych is a physician assistant who blogs at A PA View on Medicine.

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  • http://twitter.com/DrBeckerSchutte Ann Becker-Schutte

    Thanks for a lovely reminder to slow down and check in with my patients!

  • James deMaine

    Doctors often interrupt, look rushed, stand at a distance, hand on the door knob, etc.  We have lots of non-verbal ways of limiting questions so we can get on to the next patient, always being time pressured.  Perhaps we can encourage questions in some innovative ways:  secure emailing promising a response within 24 hours; asking patients to write down their questions and give them to the assistant checking them in; assuring the patients that we expect them to ask questions (as you did); use of teaching videos followed by q&a; etc.

    One physician I know actually shared the office medical record with the patient saying, “This half of page is mine, and I want the other half to be yours.  Your medical record needs to reflect both of us.”  As electronic medical records expand perhaps we can find a way to be transparent and inclusive so the patient truly feels that we are all on the same page and more comfortable with the doctor/patient power differential.

    • http://twitter.com/PersonalFailure Personal Failure

      I’m sure not all patients would love it, but I would love the email idea. I am much more comfortable writing and reading than speaking, so for me, the opportunity to go home, collect my thoughts and write them down would be fantastic. A lot of people are a bit intimidated by doctors, so I think, at least among people comfortable with, and with access to, email would like this.

  • Anonymous

    What a refreshing article. The doctor-patient relationship needs to be much more of a friendship or student-mentor type of bond as opposed to seller-buyer or superior-inferior. A sound relationship and solid listening skills shared with a patient can be healing in itself.

  • Anonymous

    Yes, your patient-centered care certainly shows that three people benefited greatly from your approach–Gretchen, her mother and yourself.  I hope you continue to pursue and find rewards in such patient-centered care.

  • Anonymous

     It’s amazing how one could easily assume a young person with access to technology would still have so many questions. This is why we, as health providers, need to remember that patients are inherently scared (particularly in life-threatening conditions such as cancer) therefore we need to help dissipate those fears with answers. Gretchen was quiet while other patients may be loud or angry. Experience has taught me that these patients are the ones that need answers the most. Answering a few questions can empower patients and help them manage their care.

  • http://twitter.com/PersonalFailure Personal Failure

    My favorite doctor ever never had an appointment go less than 30 minutes, because he would explain everything. He would explain to my why he chose one antibiotic over another to treat an ear infection. He would give me instructions, then have me repeat them back to make sure I got them, then would write them down for me. He had time for every possible question and never made me feel stupid for asking.

    Of course, he couldn’t make any money only doing one or two appointments an hour, so he left medicine over 10 years ago. I really, really miss him.

  • http://profiles.google.com/mittmanpa David Mittman

    That was an awesome post.
    I can’t tell you how many people I see personally who I have to say “SLOW DOWN” to. Tell them I am a PA and maybe because of that handicap we need to take things more slowly and connect a bit.
    Dave

  • http://www.facebook.com/people/Ron-Gutman/1078481789 Ron Gutman

    This
    is an amazing testimonial to the dire need that patients have for a
    reliable and trustworthy source of personalized health information. It’s
    also a reminder to us on how busy physicians are and how pressured they
    are to finalize visits quickly and meet the tough 8-12
    minutes they have per visit. HealthTap, a new service that puts physicians
    back into the center of the online conversation, enables physicians to
    answer questions and create tips under their name, in their own virtual
    practice, and make it available to their patients and beyond. This
    enables the physicians to make their wisdom available to all their
    patients and even others, in a very comprehensive and exhaustive way, in
    their own words, without spending additional time repeating the same
    answer to many patients throughout their day and careers.

  • Anonymous

    I’m an 81 year old  retired GP. I have 7 children(3 are step-)and 12 grandchildren. I have always been happy to give advice and recommendations to them all. And they love being able to depend on my experience to guide their choices of what to do and when. Many trips to the ER have been avoided. We have been so successful with this method that several of my kids get their friends to call me for advice. This experience has me wondering if current doctors might have use for retired guys like me to be available for their patients to call with questions. I have read recently that old folks dislike the things they are gradually losing, sight ,hearing and, most of all, relevance. My experience has really made me feel relevant once again. That’s worth more than enough payment.
     

  • http://twitter.com/TomBLogue Tom Logue

    Want to know why patients don’t feel comfortable asking questions? Check out this other post from kevinmd.com and imagine yourself in that patient’s shoes, with a doctor who dispenses advice such as “Whatever you do, do not bring up a new problem after the visit has already begun.”

    http://www.kevinmd.com/blog/2010/07/doctors-run-late-patients.html

  • http://www.facebook.com/edwardjreilly Ed Reilly

    Its unfortunate that most physicians are so busy, so overburdened with patients that they don’t/cant take the time to answer, usually, simple questions from their patients.  More important, there is no reasonable excuse for this happen.  We also forget that most physicians are social inept morons that have been blessed with, for the most part at least, intelligence. Unfortunately it would seem that social grace and intelligence are like oil and water in the medical field: They just don’t mix.  Whats worse most physicians are aware of this and simply don’t care.  My advice: Avoid these monsters like the plague, even if they come highly recommended.

    Great story Sharon!

    • Anonymous

      thanks Ed for the compliment.

  • Anonymous

    if any of you would like to read Gretchen’s whole story, it’s on my blog (listed above).

  • Anonymous

    As I read your article I thought of my daughter, a mildly intellectually disabled young lady.  She’s just moved out on her own and is taking charge of her own medical care.  This means that sometimes the nurse practitioner or physician has to take the time to answer her questions and be sure she understands what they are saying.  She’s a patient that shows up w/a list just to be sure she doesn’t forget to ask something.  I give her medical group kudos, particularly the nurse practitioners who she sees more often than the doctors, for helping her help herself.  They take the time (which I recognize is a very valuable commodity having worked in health care) to REALLY provide CARE for her and never rush her out the door.  Somewhere along the way too often in treating patients some providers have forgotten there’s a reason it’s called healthcare–because not only do you have to provide your patients with information and suggestions and occasionally a script, but because you have to show you CARE so patients feel comfortable bringing their health questions out in the open, even if sometimes they are uncomfortable topics.