Two Side of the Same Story
2 Sides of the Same Story

Communication Can Get Everyone on the Same Page and Lead to Happier Endings

  • Rebecca Harrington, MSLIS, AHIP

Communication between provider and patient goes both ways. In order to get the most out of time spent during visits, providers and patients should consider the sample questions and tips included in this article to help facilitate communication.

The Provider’s Perspective

Healthcare providers recognize that with only 5 to 10 minutes per average consultation, there is little time for meaningful dialogue between patient and provider. Asking patients “What is the most difficult part of living with diabetes?” or “What are your greatest concerns about your diabetes?” can often get right to the heart of the matter.

Sample Questions for Providers

Follow-up questions:

  • Confirm your understanding by repeating the patient’s concerns back: “Let’s make sure we talk about __ and __. It sounds like you also want to make sure we cover __. If we can’t get to the other concerns, let’s…”
  • Screen for emotional distress/depression: “Have you been feeling down or overwhelmed? Are you having problems sleeping or concentrating?” Using a short questionnaire, such as the WHO-5 (http://www.dawnstudy.com/News_and_activities/Documents/WHO-5.pdf), can help to monitor emotional well-being in patients.
  • Explore barriers: “What do you think would help overcome any problems you might have with the treatment plan?”
  • At the end of the appointment, be sure to ask “What questions do you have about what we discussed today?”

Other tips to improve communication include:

  • introduce yourself to everyone in the room;
  • consider the patient’s cultural background and use appropriate gestures, eye contact, and body language;
  • explain rationale for tests and treatments in plain language;
  • review possible side effects;
  • provide written materials in the patient’s preferred language when possible;
  • discuss treatment goals to ensure mutual understanding and agreement;
  • assess the patient’s ability and motivation to carry out the plan;
  • verify comprehension by asking the patient to repeat instructions; and
  • summarize visit and review next steps.

The Patient’s Perspective

Most patients with diabetes receive their care from a primary care physician. Primary care doctors’ appointments are usually scheduled at 15-minute intervals; these appointments need to be as efficient as possible. It’s important to bring:

  • the results of any home tests, such as blood sugar or blood pressure levels;
  • a list of all medications (including over-the-counter), noting the doses and the frequency; and
  • estimates of daily living habits (eating, drinking, exercise, smoking, and sleeping).

Patients who write down questions in advance are more likely get their questions answered since they are not struggling to find the right words. Ranking questions in order of priority ensures the most important questions are addressed.

Sample Questions for Patients

  • What are my ABC values (A1C, blood pressure, and cholesterol), and what do these values mean? What should my targets be?
  • How do I take my medications? What should I do if I miss a dose? What are the side effects of these medications?
  • What kind of dietary guidelines should I be following? How can I eat healthy on the go—like on weekends, at work, and when going out?
  • How often should I check my blood sugar level at home? Should I do it at different times of the day? How can I use the information from this monitoring to better manage my diabetes?
  • What are the complications of diabetes? What lab tests or examinations do I need to get on a regular basis to lower my risk of complications?
  • I have other medical problems. How can I best manage these conditions together?
  • What are the signs and symptoms of low blood sugar? How do I treat low blood sugar?
  • What are the signs and symptoms of high blood sugar?
  • When should I test for ketones, and how do I do it?
  • How should I take care of my diabetes when I am sick?
  • Who else do I need to see for my diabetes care (eye doctor, endocrinologist, podiatrist, dentist, and dietitian)?
  • What were the results of my lab tests? May I have a copy of my results? What do they mean?
  • What if I am having a hard time dealing with diabetes?
  • How can I find out about local diabetes education programs?
  • What resources are available if I’m having trouble paying for diabetes supplies?
  • When should I schedule my next routine visit and how often should I be coming for appointments?
  • What should I focus on prior to my next visit?

Other tips to improve communication include:

  • take off your shoes and socks to remind your doctor to check your feet;
  • bring up any physical or emotional issues, such as trouble sleeping or feeling anxious; and
  • make the next appointment at the end of the current appointment.

DOI: http://dx.doi.org/10.17125/plaid.2015.39

References

  1. DAWN™ Dialogue tools [Internet]. Novo Nordisk; 2014 [cited 2015 Apr 20]. Available from: http://www.dawnstudy.com/toolsandresources/dawndialoguetools.asp
  2. Diabetes - what to ask your doctor - type 2 [Internet]. A.D.A.M. Medical Encyclopedia. Atlanta (GA): A.D.A.M., Inc.; [updated 2012 Dec 11; cited 2015 Apr 11]. Available from: http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000217.htm
  3. Dimensions of patient-centered care [Internet]. National Diabetes Education Program (US); [cited 2015 Apr 15]. Available from: http://ndep.nih.gov/hcp-businesses-and-schools/practice-transformation/patient-centered-interactions/dimensions-of-patient-care.aspx
  4. Frankel RM, Stein T. Getting the most out of the clinical encounter: the four habits model. J Med Pract Manage. 2001 Jan-Feb;16(4):184-91.
  5. Funnell M. Five questions to ask your health care team about your type 2 diabetes [Internet]. National Diabetes Education Program (US); 2012 Apr [cited 2015 Apr 20]. Available from: http://ndep.nih.gov/media/five_questions_to_ask_your_health_care_team_508.pdf
  6. Haupt A. How to maximize a doctor visit: to get the most out of those 15 minutes, start preparing before you arrive [Internet]. U.S. News and World Report Health; 2011 July 26 [cited 2015 Apr 20]. Available from: http://health.usnews.com/top-doctors/articles/2011/07/26/how-to-maximize-a-doctor-visit
  7. Nine questions for your diabetes care team [Internet]. Joslin Diabetes Center; 2015 [cited 2015 Apr 20]. Available from: http://www.joslin.org/info/9_questions_for_your_diabetes_care_team.html
  8. Ten questions to ask your doctor [Internet]. Men’s Health; 2015 [cited 2015 Apr 20]. Available from: http://www.menshealth.com/spotlight/diabetes/doctors-questions.php
  9. Type 2 diabetes: preparing for your appointment [Internet]. Mayo Clinic; 2014 Jul 24 [cited 2015 Apr 12]. Available from: http://www.mayoclinic.org/diseases-conditions/type-2-diabetes/basics/preparing-for-your-appointment/con-20031902

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