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5 Reasons Why People Don’t Ask Their Doctor Questions

A neighbor of mine was diagnosed with breast cancer about the same time my wife was being treated for lung cancer. I saw my neighbor the other day for the first time in several years. I asked her how she was doing. She said great. In turn I asked her how her PET/CT exam looked. PET/CT scans are often done to make sure that one’s cancer hasn’t spread. My wife gets one every year.

My neighbor told me her doctor never told her she needed one, that mammograms would suffice. She went on to say a friend had also recently asked her if she had a PET/CT as well. “Maybe I should ask my doctor,” she told me. That was the same response she gave me the last time I raised the subject two years earlier: “I should ask my doctor.”
 
So Why Don’t People Ask More Questions?
 
My neighbor is not alone when it comes to asking their doctor questions. In an earlier post, I cited research which found that patients ask their doctor an average of two important questions during the office visit. According to researchers, there are five reasons why people don’t ask their doctor questions.

These reasons include:

Fear – fear of what the doctor may think of them, fear of what the doctor may say, fear of looking or sounding stupid in front of the doctor, fear of getting the wrong answer.

The doctor knows best – if something is important the doctor will mention it, if I need the test the doctor will order it, and so on.

Not wanting to interrupt – office visits follow a clear pattern: opening statement, medical interview and exam, diagnosis, treatment and closing. Other than during their opening statement, most patients realize that the doctor does most of the talking.

Not being asked by the doctor if they have any questions – studies show that physicians do not ask patients if they have any questions in more than 50 percent of office visits.

Feeling rushed – feeling that their question isn’t really all that important after all.

In my neighbor’s case, I suspect that “fear of knowing” the results of a PET/CT scan may be the overriding reason why she has not asked her doctor about having the exam.  Why invite bad news if you don’t need to. Fear is a pretty strong motivator. Strong enough in many instances to trump another strong motivator –- one’s survival instinct.

If You Have A Question, Write It Down And Give It To Your Doctor

One way for patients to ask their doctor questions is to write them down before the visit and give them to the doctor at the start of the visit. That way patients can avoid having to worry about how or when to ask a question. Physicians should invite patient questions, even at the risk of extending the office visit.

REFERENCES:

Roter, D.L. “Patient Question Asking in Physician-Patient Interaction.” Health Psychology. 1984; 3 (5) 395-409.

Cegala, D. Personal notes. 3/12/2010.

*This blog post was originally published at Mind The Gap*


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One Response to “5 Reasons Why People Don’t Ask Their Doctor Questions”

  1. Philos says:

    This article is good…I have myself said fine when asked how I was doing by a doctor while in reality I was sick. I hate it also when the doctors shows lots of sympathy my way. When that smile fades and replaced by pity/sympathy that to me I deem to much, the questions just fade off my mind.

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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

***

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