Questions, Questions: Getting The Most From Your Patients

Open questions invite patients to reflect before answering

During your training you learned the importance of gathering information from patients in order to help them. You were probably taught to work with a list of standard questions.

Here are a few questions for you:

  • When you consult with patients, are you still working from the same ‘script’?
  • How often do you think about the precise reasons for asking particular questions?
  • When did you last review your questioning techniques?

Your list of questions can appear to work well when patients give you the basic information you need, but you are probably missing out on useful insights.

Do you know how to adjust your questioning to get more, and more specific, information?

Types of Questions

Closed questions

These are questions that typically require only a ‘Yes’ or ‘No’ answer. At the beginning of a consultation they are useful for gathering information and establishing facts. They have several limitations.

Closed questions:

  • Are led by the practitioner
  • Severely restrict information given, and constrain the range of possible replies
  • Do not engage patients in useful communication – particularly those who are reserved, quiet, sad or even depressed
  • Require us to ask more and more questions to get the information we need.

Open Questions

Open questions invite patients to reflect before answering, and provide plenty of latitude for their responses. They need to be designed carefully, however, to achieve particular purposes.

Open questions can:

  • Recover information
  • Direct attention
  • Clarify meaning
  • Offer your patient choices
  • Build (or break) rapport
  • Elicit resources
  • Challenge assumptions
  • Elicit values
  • Orient patients by asking about past, present or future
  • Elicit outcomes
  • Suggest strategies
  • Summarise

The Value of Asking Open Questions

Some examples of situations where open questions are especially useful:

When working with more challenging patients

Patients managing chronic conditions have often spent years being told what to do. This renders them passive in their recovery process. They might be unable to come up with options that could influence their treatment outcomes. It can be very useful to ask these patients open questions, so they begin to think about what will work for them, and any obstacles they might need to consider.

Patients who talk a lot might still avoid giving specific answers. Carefully phrased open questions direct their attention more narrowly.

When used to provoke a ‘transderivational search’

‘A transderivational search is when the listener goes through their ideas, memories and experience to search for meaning that will help them make sense of the question.’ Joseph O’Connor & Andrea Lages

The form of this type of open question is important, because it sets limits on the extent of the search the listener (your patient) will make.

Sample scenario:

Towards the end of a consultation, you are ready to give patients recommendations or exercises to do at home.

A common way to ask the question:

‘Can you do these exercises?’ (often adding ‘for me’)

This closed question limits patients’ search to their ability to do the exercises.

The patient simply answers ‘Yes’, implying ‘Yes, I can’. Patients who don’t go on to do the exercises will feel no remorse; they have answered truthfully, but chosen not to do them.

A better question:

‘When will you do your exercises?’

There is an embedded command for the patients to do the exercises. You just want to know how they will fit them into their schedule. This time the transderivational search directs patients towards the time they will do the exercises, or any time-based obstacles they might have.

This question elicits resources from the patient’s perspective. The answers will help you understand your patients’ time limitations and allow you to help them with time management, before they leave the consultation.

Another good question:

‘What needs to happen for you to get these exercises done?’

This time the transderivational search leads patients to come up with options or possible hurdles to overcome in relation to doing the exercises. This is also useful information, as you can help them work out resolutions to any difficulties they believe they have. You might even need to adapt your home program in response to what they tell you.

When used to challenge excuses

When you hear excuses your role is to ask open questions that elicit possibilities.

Sample scenario:

Your patient tells you: ‘I’m just too busy to fit these exercises into my schedule’.

Possible questions you could ask:

‘How might you be able to fit them into your busy schedule?’

‘What needs to happen for you to fit them into your busy schedule?’

‘What do you think you might be able to change to fit them in?’

‘How confident are you that you can fit them into your busy day?’
‘Of the various options I’ve given you, which one seems the most possible for you to fit in?’

These questions lead patients to explore possible solutions to the problem – i.e. time management.

It is a more effective method than telling patients how to fit exercises into their day.

Summary:

  • Revisit the list of questions you ask your patients.
  • Think about what information you really want before asking questions.
  • If you are not getting the information you need, think about the purpose of your questions and adapt them where necessary.
  • Even though the ‘theme’ of a question is the same, the way you ask it will elicit different responses.

Asking the right questions is empowering for your patients.

Clarifying miscommunication is always the responsibility of the questioner. In other words … YOU.

To learn more about motivational tools through effective communication download my eBook

“Improving Patient Motivation In Physiotherapy”

I wrote this eBook in response to the most common question I get asked and that is “How do I motivate my patients?”

If you would like to fine-tune your communication skills when working with resistant patients, you might consider working with a coach or mentor.

Or perhaps your staff would benefit from training in this area.

Contact us, and find out more about what we can offer you.

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