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Asking the right questions

By asking open instead of closed questions, health professionals encourage patients to formulate a longer answer instead of yes/no.
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JANNE TULLIUS: Appropriate questions can be a really important tool if used well. The purpose of questions is to elicit information to promote informed decision-making with patients. We are going to see a video of Mrs. Phillips attending a physiotherapist after suffering a badly broken wrist which required surgery. The wrist is on her dominant side, and the injury has resulted in limited dexterity and a lack of fine motor movement. The physiotherapist has information on Mrs. Phillips’ injury in advance of the consultation. We join them at the therapist’s office after introductions have been made.
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PHYSIOTHERAPIST: What are you hoping for as an outcome? MRS.
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PHILLIPS: Mm. Um– I would like to be back to the way I was.
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PHYSIOTHERAPIST: Well, we are going to do everything we can, but given the extent of your injury and age, we may only get back to 80% to 90%. I need to get an idea of what you do, so can you give me some examples of things that you do and the things you would like to go back to? MRS.
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PHILLIPS: Like what?
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PHYSIOTHERAPIST: Do you play the piano, for example? MRS.
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PHILLIPS: [CHUCKLES] No. But I type for work, and, um, I need to be able to write legibly, and to pick up things like coins. It’s my dominant hand. I’m worried about it.
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PHYSIOTHERAPIST: Yes, I can understand that.
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JANNE TULLIUS: The physiotherapist has been asking open questions which has facilitated engaging interaction rather than generating a sense of interrogation, often felt by people when closed questions are used. She acknowledges Mrs. Phillips’ concerns and provides clear and honest information. Let’s go back to them towards the end of the consultation.
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PHYSIOTHERAPIST: What questions do you have for me? MRS.
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PHILLIPS: Will I get back to how my arm was before?
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PHYSIOTHERAPIST: Well, with exercise and massage, we will get it as good as we can, between 80% to 90% of what it was.
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MRS.
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PHILLIPS: I assume it’s a long process.
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PHYSIOTHERAPIST: Yes, it takes a long time.
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JANNE TULLIUS: The physiotherapist continues with open questions. The wording of the questions is really important to generate and facilitate engagement. For example, she asks, “what questions do you have for me” rather than “do you have any questions,” a question which is very easy to say no to and tends to finish the conversation.

Health professionals can make it easier for all patients to ask questions.

Instead of finishing an appointment by saying Do you have any questions? The easy answer and most likely is No. Instead ask What questions have you got for me?

What is the difference between these two questions?

The difference between closed questions, which you can answer yes/no to, and open questions, which you can’t and are likely to have to provide a longer answer. Open questions, like What questions do you have for me?, give respondents the opportunity to include more information in their answer, including feelings, attitudes and understanding of the subject. This gives patients the chance to formulate a more thorough response, but also provides health professionals with more information about the level of a patient’s understanding of their health and symptoms, but also level of communication. Respondents also often feel less threatened by an open question as it is evident that there is no right or wrong answer.

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Working with Patients with Limited Health Literacy

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