Abstract
Background/Aims Encouraging patients to ask questions in clinical visits is seen as a key to engaging patients. Multiple interventions have focused on activating patients to ask questions when visiting physicians. We know little about whether patients with mental illness ask questions in primary care visits, how their question-asking behavior is associated with physicians’ relational communication and the length of visit.
Methods We conducted in-depth mixed method analyses of 322 audio-recordings of periodic health exams (PHE) made by patients 50–80 years of age. Patients included those with mental health (MH) needs, based on 2-item Personal Health Questionnaire (PHQ2) scores (2 or greater), on having filled or been prescribed a psychotropic medication, on having a MH diagnosis or visited a MH provider in prior 12 months, or on having a MH discussion in the visit. Using transcribed recordings, each conversation was categorized into “topics,” which were grouped into three categories: biomedical, MH, or other. Multivariate models were estimated using generalized estimating equations.
Results About 99% of patients (319 of 322) asked at least one question. Patients asked questions throughout the visit, averaging 18 per visit. Half of them asked their first question within the first 1.4 minutes. Patients were more likely to ask a question if a topic discussed a medication (OR = 1.57, P <.01) and less likely if the topic was about MH issues compared to biomedical issues (OR = .51, P <.01). PHQ2 score was not a significant factor. The number of patient questions was negatively correlated with ratings of their physicians’ relational communication. Each additional question was associated with a 12-second increase in visit length (P <.01).
Conclusions Patients ask many questions, and they ask them early and often. The number of patient questions was associated with unfavorable views of physician relational communication and with slightly longer visits. Patient engagement efforts need to move beyond simply encouraging them to ask questions.
