Researchers at The Right Question Institute are on a mission to help us ask the right questions. They started in education when they found out that the commonest reason for low income parents’ low attendance of meetings with teachers is that the parents did not know what questions to ask.
They started by giving the parents some questions to ask for different situations e.g. school budgetary decisions or why a child was being suspended. That didn’t quite work:
We went to one of the meetings where parents had these question lists and they’d go up to the microphone and read questions from the list. But as soon as they were asked a question by someone from the school, they’d turn back to us, like what do I do now?
The founders, Rothstein and Santana, switched from scripts to coaching. The key was for the parent to learn how to find out the:
- reason behind a decision
- process that led to the decision
- role parents could play in that process
The team created a similar framework for patients, The Right Question-Effective Patient Strategy™ (RQ-EPS). Here it is applied in two different scenarios. First, a parent brings a child with a fever to the doctor’s office. The doctor says no to antibiotics, a common response that commonly frustrates parents. The parent should ask for the:
- reason: “why doesn’t my child need antibiotics?”
- process: “how is this different from 3 months ago when my child did get antibiotics?”
- role: “what should I do if the fever doesn’t go down?”
Here’s another scenario: a patient comes to an appointment complaining of long-term back pain. The doctor talks through the treatment options and asks the patient to choose between medication, exercise, complementary therapy and surgery. Do patients know best after such a consultation? Often, they are overwhelmed and just ask their physician: tell me which is best. Instead, the patient should ask:
- reason: “If surgery solves the problem, why wouldn’t I choose it?”
- process: “do I need to choose one today?”
- role: “before I choose one, what else do I need to know?”
And so on. This changes patients from passive to active:
|The passive patient…||The effective patient…|
What does this mean in practice? Summarised in the researchers’ own words:
Medical students taught the RQ-EPS during a study on patient activation to mostly low-income, minority patients in waiting rooms of community health centers in New York City. They saw, on average, an eight point increase in patient activation.
Further, the researchers assessed the patients’ preference for control – whether they preferred an active, collaborative, or passive role in their health care. Patients across each of the three preferences saw significant increases in activation after learning the RQ-EPS. Yet passive patients had the greatest increase with over nine points.
And here are their publications:
- Alegría, M., Polo, A., Gao, S., Santana, L., Rothstein, D., Jimenez, A., Hunter, M.L., Mendieta, F., Oddo, V., Normand, S.L. (2008). Evaluation of a patient activation and empowerment intervention in mental health care. Med Care, 46(3), 247-56.
- Cortes, D.E., Mulvaney-Day, N., Fortuna, L., Reinfeld, S., Alegría, M. (2009). Patient—provider communication: understanding the role of patient activation for Latinos in mental health treatment. Health Education & Behavior, 36(1), 138-54.
- Deen, D., Lu, W.H., Rothstein, D., Santana, L., Gold, M.R.(2011). Asking questions: the effect of a brief intervention in community health centers on patient activation. Patient Education and Counseling, 84(2), 257-60.
Lu, W.H., Deen, D., Rothstein, D., Santana, L., Gold, M.R. (2011). Activating community health center patients in developing question-formulation skills: a qualitative study. Health Education & Behavior, 38(6), 637-45.
I think doctors need to answer questions patients pose to them rather than skirting around issues and avoiding giving direct answers.