Last weekend we conducted a training for Tufts undergraduate students about the Right Question-Effective Patient Strategy (RQ-EPS) and how they could teach it to patients. The students volunteer at the Sharewood free clinic and provide information about public health topics, check patients’ vitals, and refer patients to a case manager. They inform patients they can sign up for health insurance and receive a flu vaccine. The students´ role in the clinic is similar to that of a patient navigator.
After a brief overview to the strategy, we split off into small groups where the students went through the strategy step by step (“experiencing RQ-EPS”). They then role-played teaching it to other students. Many found it tough to break out of the habit of “interviewing” the patient. Through RQ-EPS, they learned how to prompt patients to come up with their own questions and to listen patiently instead of jumping in to answer or ask a follow-up question.
We reflected in small groups after they practiced teaching the strategy. As I listened, one word kept popping up – a word that felt, at first, like an obstacle. I later realized it was something to embrace.
Awkward.
“It feels awkward to ask, ‘what questions do you have about meeting with a case manager?’ because it assumes that they have questions. What if they don’t have questions?”
The student was naming the problem with the status quo. Too often we assume that patients don’t have any questions. So yes, it does feel awkward to instead assume that patients do have questions. But if that is our goal, to have patients asking questions and engaged in their health, it’s worth overcoming a little awkwardness to get there. And if the patient doesn’t have any questions at first, we have a strategy to help with that.
“It feels awkward to collect these questions when we can’t answer them. We don’t have the medical experience.”
Again, it’s the shift away from standard practice that feels awkward. For most of us, it is instinctive to answer a question when asked. The Right Question Strategy teaches us to wait. We need to ask more than one question in order to get the information we really want to know. And as this student states, our role may end before the answering begins. We need to appreciate that yes, answers are important, but we get even better answers when we ask better questions.
Embrace the awkward at the beginning – with practice, it will start to feel natural.
From the patient perspective, the whole topic of this blog post is crazy making. Always assume the patient has questions. Always!
– Ask them what questions they have and help them clarify the information they want to gather.
– Ask them what information they feel it would be important for them to know after they’ve met with the case manager.
The heart and soul of patient centered care is when the physician or other health care provider continues to ask questions all the way through to the end of the patient encounter … including the treatment plan. As soon as you begin to give orders you cut the patient out of engagement with their own care. This is truly a “DUH” moment for anybody outside of the healthcare system. Orders don’t work. Questions do.
My two cents,
Dike
Dike Drummond MD
http://www.TheHappyMD.com
Thanks for reading and commenting, Dike.