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Encouraging patients to ask questions

In this video a healthcare professional encourages her patient to ask questions.
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JANNE TULLIUS: This is Alexia, a 23-year-old student who came to her local public health clinic to talk about changing her birth control options. She has been using the birth control pill, but she tends to forget to take this pill every day. Her counsellor advised her to change to the Depo shot. This is where we pick up the conversation.
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DOCTOR: Well, the Depo shot is an injection you get every three months. It’s a very safe, convenient, and private birth control method, and it works very well if you get the shots on time. So let me tell you how the Depo shots actually work. They contain the hormone progestin. Progestin stops you from getting pregnant by preventing the ovulation. When there’s no egg in the tube, you can’t get pregnant. It also works on your cervical mucus. When the mucus on the surface gets thicker, the sperm can’t get through. And when the sperm and the egg can’t get together, pregnancy can’t happen. So what questions do you have about that?
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JANNE TULLIUS: A good way to encourage patients to ask questions is to use open-ended questions like this one. Avoid asking close-ended questions, such as, “Do you have any questions?”, as this often leads to a quick “no”, even if patients do have questions. Now let’s see how this conversation continues.
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ALEXIA: Yeah, I think I get it. I really like that I don’t have to think about it every day. So do I have to go to the clinic, then, every three months? What if I forget?
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DOCTOR: I understand you’re worried, but you shouldn’t be. For the Depo shot to work, you have to get a new shot every 12 to 13 weeks. That’s every three months or four times a year. Most of the time, the doctor or a nurse will give you the shot. You have to make an appointment at a health centre and remember to get to your appointments. You may also be able to get a supply of shots at the health centre to bring home and give yourself. You can use our birth control app to keep track of when you need your next shot or your next appointment.
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It might also work to add it to any calendar you use or to ask a family member or your partner to remind you.
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JANNE TULLIUS: Besides verbally encouraging questions, it is important to invite questions using body language. The counsellor in this video does that very well by sitting at the same level as Alexia, leaning towards her a bit, looking at Alexia when talking and listening as opposed to looking at a computer or notes, being conscious about presenting herself as having time and wanting to listen to Alexia’s questions. Now let’s see how this conversation continues.
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ALEXIA: Yeah, I think using an app to remind me would work really well.
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DOCTOR: Yeah, it sounds like remembering something every day is very difficult for you. But remembering appointments with an app works really well. Being on time for the Depo shot is really important for protection against pregnancy.
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ALEXIA: Yeah, I get it. I really don’t want to be pregnant right now, so I know I can’t forget to take my shots.
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DOCTOR: OK, good. What other questions do you have for me?
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JANNE TULLIUS: To encourage patients to ask questions, it is important that you do this during the whole consultation. So ask patients what questions they have several times during an office visit. You can use various formulations, such as, “We discussed a lot of information. What can we review again?” Or, “This may be new to you, and I expect that you have some questions. What would you like to know more about?” Try it out.

The main advantage of using the Ask Me 3 approach is that patients have a concrete tool they can use to make sure they receive all necessary information from their healthcare provider.

However, there are also some drawbacks. One is that it is actually the healthcare provider’s responsibility to ensure that the person understands their situation and what they have to do – not the patient. In this video you can see how a healthcare professional can encourage his/her patient to ask questions.

The strategies that are used by the counselor in this video include:

  • Asking open ended questions
  • Using body language: sit at the same level, look and listen, taking the time
  • Encourage questions multiple times during the consultation

After watching the video, please reflect on the following question:

How is enabling patients to ask questions empowering?

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Working with Patients with Limited Health Literacy

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