Coaching for doctor office visits helps patients ask right questions

The review appears in The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

When interventions took place immediately before a consultation, they resulted in a small but significant increase in the duration of the office visit. Interventions that occurred some time before the consultation had no effect.

In general, interventions produced small increases in patient satisfaction, plus a possible reduction in patient anxiety before and after visits. Coaching had a slightly larger benefit in patient satisfaction than providing question checklists.

“Coaching is a more intensive intervention and may have some therapeutic impact,” said Kinnersley, co-director of the Communications Skills Unit at Cardiff University in Wales.

At the very least, coaching helps patients voice and rehearse their concerns.

“Patients need to have the courage and confidence to ask questions,” said Sherrie Kaplan, Ph.D., co-director of the Center for Health Policy at the University of California, Irvine. “Many patients don’t want to look stupid. Studies have shown that even doctors find that when they are patients, they don’t want to ask questions that will make them look stupid.”

The review also looked at the value of refresher courses in communication skills for doctors.

Doctors can underestimate their patients’ information needs for a variety of reasons, according to the review authors. When treating patients with serious or life-threatening illnesses, doctors might be reluctant to dispense information that they feel could be harmful or disturbing. Alternatively, they sometimes focus so hard on confirming a diagnosis that they do not take the time to encourage patient involvement in constructing more individualized treatment approaches.

“Doctors are prepared to ask questions, to formulate what’s wrong, find it and fix it,” Kaplan said. “In studies we’ve done, the patient will talk for about 30 seconds before the doctor interrupts with more questions and takes over.” Kaplan was not involved with the Cochrane review.

According to Kinnersley, doctors do benefit from refresher courses in communication, even if they are not always eager to go.

“Pretty much every medical school will teach communication skills and assess them before qualification, but we still have evidence that patients are dissatisfied with doctors’ communication skills,” Kinnersley said. “I think the problem is that after qualification, doctors learn a lot more clinical knowledge and they get more enveloped by medical culture. Thus, their communication skills often deteriorate. They focus on curing the patient rather than caring for them.”

The review found small increases in consultation time when doctors received training, but found no significant increase in patient satisfaction. Ultimately, the review recommended more studies to compare methods of intervention, intervention timing and the possible benefits of additional training for health care providers.

The review studies covered a variety of settings and diagnoses, including primary care, cancer, diabetes, women’s issues, heart problems, peptic ulcers and mental illness. It is possible that the more serious the illness, the greater the level of anxiety might be and the more intimidated a patient will feel about asking questions, Kinnersley suggested.

“If patients are anxious or the answer to a question might be frightening, you’re going to need more encouragement to ask questions,” he said.

For Kaplan, the key to getting the most out of any doctor visit and reducing anxiety is preparation. She compares preparing for a doctor visit to studying for a test.

“Anxiety can affect your memory but if you haven’t prepared to take a test, whether you’re anxious or not, you are not going to do well,” said Kaplan. “You need to prepare so you can be cool, calm and collected. Patients need to meet the doctor halfway and doctors need to give patients the sense that there is some way they can get involved in their own treatment.”

By Joan Vos MacDonald, Contributing Writer Health Behavior News Service

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Kinnersley P, et al. Interventions before consultation for helping patients address their intervention needs (Review). Cochrane Database of Systematic Reviews 2007, Issue 3.

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.