Lessons I Learned from Farrago: Get Ready for “Dumb” Questions
Most patients do not have all their questions answered during a typical medical visit. Multiple studies indicate that patients frequently leave consultations with unaddressed concerns or unanswered questions, often due to time constraints, communication barriers, or incomplete agenda setting by clinicians. For example, research shows that physicians solicit the full agenda of patient concerns in only a minority of visits and often redirect patients before they have finished stating their concerns, leading to late-arising or unaddressed issues. Even when physicians ask if patients have questions, the format and timing of these solicitations significantly affect whether patients feel able to raise additional concerns.
Patient factors such as health literacy also play a role; those with lower literacy levels tend to ask fewer questions and may not fully understand or recall information provided, further contributing to unmet informational needs.
Interventions such as pre-visit guides or question-prompt lists can modestly increase question-asking and satisfaction, but the overall effect remains limited, and established consultation behaviors are difficult to change.
But change we must; especially when entering DPC. One of the biggest claims to fame of this model is that we have time with and for our patients. This means we will get to that fifth or sixth question on their list, even if it means coming back at a separate visit for those questions and concerns. Also, our patients often have access to us by email and/or text. Again, even when appropriate boundaries are placed on this, it gives them access to ask questions that are not easily facilitated due to time (and increasingly cost) constraints in the broken, fee for service, third-party system.
As such, Doug warned me that I need to be ready for “dumb” questions. Of course, he didn’t really mean dumb. We have years more training and experience than most of our patients. (Although I have some more experienced physicians who have trusted their care to me.) It’s only natural that questions we would’ve been able to answer within our first year or two of training are on the minds of our patients who have none of that training. One example that Doug gave to me is people asking about all the minor abnormalities on a lab report. Our patients will want to know what a slightly elevated MCV means, even if the rest of the CBC is normal, etc.
Perspective is important here. While some of these questions may seem dumb, simple or unnecessary to us, they generally reflect an engaged patient, something we want. And yes, occasionally these come from an anxious patient. In the context of healthy boundaries, clearly communicated and reiterated, these “dumb” questions build relationship and satisfy patients. Satisfied patients build your practice and reduce churn. Engaged and satisfied patients that are loyal to your practice and advertise for you? Bring on the ”dumb” questions!
Appreciate the thoughts. I have a meeting with the local school district next week. The employees are now traveling 15 miles away for health care to the town over because the two local systems must have out priced themselves. I’m going to see what I can go. Your comments will give me good points for the school district to ponder.