Asking patients what they want you to do about their illness

PhysiologyRocks

There seems to be a divide in relation to asking this question:

Some think it's a great idea, as it helps to assess the patient's expectations of the doctor.

Others rather not, as the question can seem poorly placed. It can also make a patient think that you don't know what you're doing.

Another similar question some advise us to ask patients is "what do you think is causing the problem?"

I'm undecided as to whether or not they should be asked. What do people here think?

PhysiologyRocks

goat2 wrote: »

where does that question come from
shurley if i pay 50 euro to a doctor to help with a problem
i expect him her to do their best to find out what is wrong, and treat the illness accordingly

Some lecturers advise medical students to ask patients these questions.

Some patients hate them. Others don't.

The 50 euro has nothing to do with this thread. My question is about medical communication skills.

mardybumbum

Its mentioned in Talley & O Connor. Personally, I wouldn't ask it.
Theres no way of phrasing it without sounding rude, or like you got your degree in a box of cornflakes.

Me: Doc, I have an awful pain in my tummy.
Doc: And what would you like me to do about it?

Just doesn't sound right.

Theres good sections on this type of thing in Kumar and Clark. The way you phrase a question can make all the difference.

PhysiologyRocks

mardybumbum wrote: »

Its mentioned in Talley & O Connor. Personally, I wouldn't ask it.
Theres no way of phrasing it without sounding rude, or like you got your degree in a box of cornflakes.

Me: Doc, I have an awful pain in my tummy.
Doc: And what would you like me to do about it?

Just doesn't sound right.

I'm largely with you on this.

The only advantage I see is if you ask a patient what they think is causing it and they say it's the spirits of their ancestors, you may be on to something.

mardybumbum

PhysiologyRocks wrote: »

I'm largely with you on this.

The only advantage I see is if you ask a patient what they think is causing it and they say it's the spirits of their ancestors, you may be on to something.

Perhaps " Is there anything that you think my be causing this problem? " is a more open ended question than " What do you think is causing the problem? "


Edit: I think its very important to ask the above question. It was the " What would you like me to do it about it? " question that I feel is unecessary.

PhysiologyRocks

mardybumbum wrote: »

Edit: I think its very important to ask the above question. It was the " What would you like me to do it about it? " question that I feel is unecessary.

Misread your previous post - studying pathology at the minute.

I normally address the cause question by asking had/has anything changed recently... I approach it sneakily! Feel like a bit of a turnip asking it straight! And still a little unconvinced of the benefits of it as a straight question.

Jessibelle

I think it depends on the nature of the illness. If I went to a doctor with, for arguments sake, a sinus infection, and they asked me what I would like them to do about it, (slightly better phrased than that but you get the jist), it opens the door to talking about alternative/holistic treatments vs antibiotics, whether it's a reoccurrent infection, if there's other factors etc. If on the other hand I went to the doctor for cancer treatment, I want my doctor to know what they are going to do, and explain it to me, rather than asking me a question, which if I was asked it at that point, would nearly have me questioning their competence.

Kurtosis

From a non-doctor's perspective, I'm not sure about asking such a question, but perhaps clarifying/identifying what the patient's expectation is of the solution/treatment you propose to provide them with and then addressing how appropriate such expectations are. As for exact wording, I'd have to think about it

PhysiologyRocks

When I go to my GP, I want her to tell me what to do.

I suppose some patients don't like that...

By my logic, she's a doctor, and I'm not one yet - Therefore, I'd rather rely on her knowledge than mine.

She would let me choose if there were a few treatment options (provided there was nothing serious wrong), but I think I'd get a fright if she asked me open-endedly what I wanted done!

I do, however, see huge value in finding out what the patient's fears are.

sam34

i wouldnt generally ask teh q as open ended as that - can of worms!


i'd usually say something along the lines of "there are a few ways we can tackle this..." and outline them all, risks, benefits etc, and leave teh decision to them (but making a recommendation all the same)

but sometimes, you have to alter this approach

some patients want you to be entirely prescriptive, just to tell them what to do

some patients dont want to know anything "get on with whatever you have to do doctor!"

some patients lack teh capacity to make the decision, and thats a whole other ball game

the only time i ever nearly said "and what do you want me to do about it?" was when an 84 year old man said "i havent had an erection in 5 years"...it was my instinctive response and i just stopped myself in time from uttering it, thankfully as it would have been wholly inappropriate!!
:eek:

goat2

PhysiologyRocks wrote: »

Some lecturers advise medical students to ask patients these questions.

Some patients hate them. Others don't.

The 50 euro has nothing to do with this thread. My question is about medical communication skills.

i apologise
see now this the medical profession having a discussion


this is just something i laughed at years ago
which really happened

a guy of abour 75 went to our local GP who was not long
in town
the GP asked him what was wrong with him
he answered, if i knew that i would not be here

mardybumbum

PhysiologyRocks wrote: »

Misread your previous post - studying pathology at the minute.

I normally address the cause question by asking had/has anything changed recently... I approach it sneakily! Feel like a bit of a turnip asking it straight! And still a little unconvinced of the benefits of it as a straight question.

Start pathology on monday. Have been reading through my Robbins and Cotran. Looks like a very interesting subject.

When we are taking histories we have been told to introduce ourselves, ask the patients permission to question them, and then start off by asking them " So what has brought you to the hospital today ? ".
I think its a pretty decent way to start a history. Some patients divulge a lot of information, and others are more reserved.

_Whimsical_

I was just wondering what the suggested responses to the question " what would you like me to do about it?" are. It seems like the only responses could be "make it better" or "reassure me it's not anything I should be concerned about".Surely both those requests are implied by you presenting to the Dr in the first place.

From a patients point of view I think Id feel a bit like my problem was being belittled if a doctor asked me that despite the tone or manner used.It doesn't sound like it would facilitate effective communication at all."How can I help?" would be a much better alternative if you were to ask it.

sam34

mardybumbum wrote: »

When we are taking histories we have been told to introduce ourselves, ask the patients permission to question them, and then start off by asking them " So what has brought you to the hospital today ? "

be prepared for them to reply "the ambulance" or "my daughter"!:p

they dont necessarily mean to be smart, but just take things very concretely

whatever actual question you start with, i think its accepted that the best way is to start with open questions and narrow it down as you go on

PhysiologyRocks

sam34 wrote: »

whatever actual question you start with, i think its accepted that the best way is to start with open questions and narrow it down as you go on

They showed us a lovely triangular structure denoting the narrowing-down! It seems to be the only logical way to go about it anyway. It'd probably feel a bit weird to do otherwise.

mardybumbum wrote: »

Some patients divulge a lot of information, and others are more reserved.

True, but some OSCE role-players only answer what's asked.

angeldelight

PhysiologyRocks wrote: »

They showed us a lovely triangular structure denoting the narrowing-down! It seems to be the only logical way to go about it anyway. It'd probably feel a bit weird to do otherwise.



True, but some OSCE role-players only answer what's asked.

That can be really annoying - one of our OSCE stations was someone coming into the pharmacy looking for something for cystitis.
Any medical conditions? Anything else I should know about before I reccomend a product? No no no yet she was pregnant argh

tech77

mardybumbum wrote: »

When we are taking histories we have been told to introduce ourselves, ask the patients permission to question them, and then start off by asking them " So what has brought you to the hospital today ? ".

^Jaysus.
IIRC Talley and O' Connor distinctly says not to phrase the question this way unless you want the reply "an ambulance".
Ba dum tish...

(IIRC the point the author was making was not to be circumlocutious).

Incidental to the discussion admittedly.

PhysiologyRocks

tech77 wrote: »

IIRC Talley and O' Connor distinctly says not to phrase the question this way unless you want the reply "an ambulance".

I love that book!

You know the way some people love novels, and read them over and over?

That is how I feel about Talley and O'Connor.

I mean, it's informative and useful, and I've actually laughed out loud in parts.

Does this make me a saddo?:cool:

mardybumbum

tech77 wrote: »

^Jaysus.
IIRC Talley and O' Connor distinctly says not to phrase the question this way unless you want the reply "an ambulance".
Ba dum tish...

(IIRC the point the author was making was not to be circumlocutious).

Incidental to the discussion admittedly.

I never said talley and o connor mentioned that.
Its our lecturers that tell us to do that.
I haven't met a patient yet who replied "an ambulance". I think I'd burst out laughing if they did.

sam34

mardybumbum wrote: »

I haven't met a patient yet who replied "an ambulance". I think I'd burst out laughing if they did.

oh believe me, it happens!

tallaght01

I wouldn't use the phrase "what do you want me to do about it?" when a person describes their ailment :P

But lots of patients have an agenda. I don't mean that in a sinister way. A patient with a cough might be desperately worried about lung cancer, say, and won't be able to sleep without specific reassurance, or a CXR (I know CXR isn't diagnostic).

Some want to be referred to a consultant, and will never be happy with a GP.

There are loads of examples. You do get a sense for it, though. Asking the patient "is there something specific you're worried about that I could reassure you about?" is a phrase I often use when I think people are worried about serious illness.

But, yea, don't underestimate how many people we send off after a quick checkover, who are still worried sick when they leave. It's always worth looking for signs of this.

Crumble Froo

tallaght01 wrote: »

But lots of patients have an agenda. I don't mean that in a sinister way. A patient with a cough might be desperately worried about lung cancer, say, and won't be able to sleep without specific reassurance, or a CXR (I know CXR isn't diagnostic).

just my 2c, from a patient perspective, i think as well that im quite happy to put my faith in my GP, but i do appreciate when she takes the time to explain my options and to explain them. questions like 'do you want me to refer you to a specialist, which will mean you'll get stuck iwth a label, but will be able to access better meds than i can prescribe', or 'how do you feel about taking medication for this' have been a big part of hte positive relationship i have with my own GP.

Victor

Um, I think its a perfectly reasonable question.

A friend was abroad and had a persistent infection in his foot. To clear the infection would have meant taking something that would have affected his balance, clarity of mind, etc. which wasn't practical for him at the time. However, he could have something that would hold the infection at bay and once he got home, he'd be able to take the other medication.

Or someone with cancer. Giving them chemo, etc. might extend their life expectancy by X time, but put them through a lot of pain for Y time. Some patients might want the time, others might want the lack of pain.

I (non-medic) had a kidney stone that I gave myself a preliminary diagnosis on. Straight to the GPs office and got their 20 minutes before he opened. He concurred it was likely a kidney stone.

Dr. "What do you want to do about it?"

Me "I need something for the pain. NOW!"

Dr. (after giving me two injections) "I'd like you to be checked out. Are you OK to go in a taxi to the hospital?"

Me (eye operating like zoom lenses, between the pain and the analgesics, left flank feeling like a land mine has gone off inside) "I not so sure about that"

Surely, it is for a patient to have at least some input into their treatment? Informed consent and all that?

seanybiker

as a person with a mental illness, (depression brought on by years of panic attacks) I find a doctor talking to me in a friendly way good.
Sorry if I am replying to wrong thread. If anyone wants to ask me how the majority of mental illness answer, I am more than happy to do it. Just Pm me.

PhysiologyRocks

In relation to the last three replies, I must clarify that I firmly believe in informed consent, and being friendly to patients.

My issue with the question is that some patients hate it, and it gives them the impression that their doctor is incompetent. I therefore would feel a bit strange asking it, and I'm unsure as to whether or not I should.

Tallaght01, thanks. That's probably the best way I could ask it without actually having to say those words!

drzhivago

Ask and you shall receive

Seek and Ye shall find

Knock and ye shall have an airport


Small anecdote about communications

I do tend to be direct with the question stated as often what my final goal of the consultation is quite different from the patients, often times after 30mins to 1 hour in ED patient not satisfied unless they got "the scan" getting to the crux iof that early on is best and figuring out why

AmcD

I think the question "what do you want me to do about it", can sound a little harsh, despite best intentions. Sometimes after a long description of some horrible psychosocial problem, I am left none the wiser as to how I am going to be of help to a patient. In that case I ask "how do you think I can help?". Often just listening is enough, but often I am taken by surprise about what the person is actually hoping for me to do.

These type of questions are not really suitable for the straight forward chest infection or gastroenteritis consults. But when the same woman comes back for the fifth time about fully investigated abdominal pain, then it is quite appropriate to be wondering what she is worried about. Usually it relates to fears about cancer or an illness that a friend or relative had.

Younger people are more open to discussions about treatment options and being involved in decision-making. Elderly people seem to tend to prefer being told what to do. As a last sweeping generalisation, there are also people who use the GP as a means to fulfilling their own treatment plans. In that case I am more of a rubber stamp and discussions about alternative or more suitable treatment options are not welcome.

paraletic

mardybumbum wrote: »

I haven't met a patient yet who replied "an ambulance". I think I'd burst out laughing if they did.

If you get a patient covered in blood, and you ask them: "where are you bleeding from?",
they might say: "I'm from bleedin' crumlin!":D