A Message:

From Dr. Shelley Simon

My regular readers will have noticed by now that my “monthly” newsletter hasn’t exactly been monthly this year. I’ve had to scale back somewhat in order to fulfill regular writing commitments for two trade journals (links to my most recent articles are posted at the end of this newsletter). In addition, I’ve had a fairly full slate of individual coaching clients and have embarked on a couple of new projects that are keeping me busy. All of this so say, I’m evaluating how often and in what format I’ll be publishing Practice Your Way during 2010 and would appreciate any feedback of ideas that you have to share. What do you like about the current format? What topics would you like to see covered? How often do you like to receive the newsletter? How’s the length . . . too long, too short, about right? Please e-mail your comments to info@beyondpracticemanagement.com.

And what about you? What are your plans for 2010? Do you have strategies in place for practice growth, staff development, and your own new learning? What financial targets do you want to reach and what new business outcomes would you like to experience? What would you like to work on next year in terms of work/life balance, personal development, and personal goals? Are you starting to ponder these issues and ask yourself the critical questions? Now’s the time!

Speaking of questions, the feature article in this issue of Practice Your Way is about how to use powerful inquiry to support your patients in achieving optimal clinical outcomes. I hope you’ll enjoy reading this piece as you begin to ask yourself the meaningful and important questions that will move you toward a healthy, sustainable practice in 2010.

Feature Article:

Using Powerful Questions with Patients to Improve Clinical Outcomes

Healthcare practitioners, as a rule, know how to establish and maintain relationships. They enjoy high levels of patient satisfaction and have an appreciation for the need to communicate and collaborate with patients. Whether by instinct or as a result of direct experience, you understand the correlation between caring relationships and positive patient outcomes — not to mention practice success.

Yet, how often have you been surprised by a seemingly compliant patient – one who understood their diagnosis, treatment plan, and what they needed to do for themselves to get better — who suddenly began questioning your approach or dropped out of care without warning? Could more effective questioning, both initially and throughout the course of care, reduce the odds of this happening?

Even if you are already skilled in using questions to diagnose, treat, and educate your patients, it’s likely that you could further improve both patient relationships and clinical outcomes by going deeper into the patient’s perspective, learning to listen for what’s not being said, and taking more risks with open-ended questions and non-leading requests for information. Asking questions that make a difference can help you:

Identify the patient’s agenda. Questioning gives you the opportunity to listen for a patient’s agenda — their concerns, needs, values, and perceived obstacles. Too often, we listen with the focus on ourselves. We nod and take notes, all the while thinking, “what does this mean to me?” Rather than paying attention to the patient’s agenda, we’re thinking about how to drive our own. Astute patients pick up on this and — consciously or unconsciously — factor it into their decision making the next time they need care. Are you truly asking a question, or are you stating an opinion or pushing an agenda?

Doctor-focused question: Since you say you’re serious about getting better, are you willing to commit to being seen at least month a month if that’s what it takes?

Patient-focused questions: What is your sense of why I am recommending this course of care? What would you like to achieve?

Build trust. When you ask questions and listen with interest and curiosity to the answers, you’re engaging in an authentic, shared experience. Active listening demonstrates that you value the patient’s perspective and respect their depth of knowledge and intuition about their own health. It’s not easy to listen well, in part because we want to control the direction of the conversation and/or the outcome. How often do you hear yourself asking “leading” questions?

Leading questions: Would you like to hear about the treatment plan I would recommend to a family member with your condition? Are you interested in correcting or patching your problem?

Trust-building questions: What do you already know about how the type of treatment that I offer might help improve your situation? What are your ideas about how I might help you?

Bring unvoiced concerns into the open. Asking “risky” questions can undercover issues that sometimes even the patient isn’t aware they have. For example, the patient who is in your office at the urging of his wife but who doesn’t believe, deep down, that you can help him. Or the patient who would like to follow your treatment plan but is wondering how she’ll pay for it. While it’s not easy to discuss these sensitive issues, you can’t do your best work with patients if their concerns go unstated.

Safe questions: Do you understand? Does that make sense? Do you have any questions?

Risky questions: What questions do you have about the treatment I’m recommending? What does this all mean to you? What are your concerns?

Encourage patients to think and learn. Sometimes the questions are more important than the answers, such as those that require a patient to reflect on their behavior, lifestyle, and self-care and how those decisions impact their symptoms, conditions, or problems. Ask questions that help patients feel accepted and support them in taking control of their health, rather than questions that come across as judgmental or manipulative.

Judging question: Are you doing your at-home exercises?

Thinking/learning questions: What ideas do you have about why you are still having this pain? What were your expectations about your progress?

Asking questions is more than a tactic or technique. It’s a reflection of your ability to listen, empathize, and take into account what patients want and need. Effective questioning is a powerful tool. What matters is how you use the tool — with what intention, attitude, and regard for the patient.

Asking questions can feel risky. What if you open Pandora’s box? Or hear answers you don’t like, such as the patient saying they’re discontinuing care or going to seek a second opinion? What if you ask a question that adds twenty minutes to the appointment? Acknowledge the risks and ask anyway. As you learn to use questions more effectively, you’ll experience firsthand what has been borne out by research: that well-posed questions and skillful communication does not lead to unnecessarily long visits and has significant benefits for both doctor and patient.

Book Recommendations:

Resources to Learn Powerful Questioning Techniques

Nonviolent Communication: A Language of Compassion, by M. D. Rosenberg

Working with Emotional Intelligence, by D. Goleman.

The Thin Book of Appreciative Inquiry, by S. A. Hammond

The 7 Powers of Questions: Secrets to Successful Communication in Life and Work, by D. Leeds

Crucial Conversations: Tools for Talking When Stakes are High, by K. Patterson, J. Grenny, R. McMillan, and A. Switzler

An Opportunity:

Are You Ready for Coaching?

Interested in achieving a new level of practice success and enjoying going to work again? Are you ready to set aside magical thinking and playing “follow the leader” and tap into your own best ideas instead? Would you like to have more authentic relationships with your patients and staff? All of this is possible with focused one-on-one coaching. The first step in deciding whether coaching would be effective for you is to request a complimentary, introductory consultation. When you schedule this session online you’ll be asked to answer several through provoking questions as a way for you to: (a) become clear on what your most pressing issues are; (b) think about what you would like to get out of our conversation; and, (c) convey to me how I can best help you. To request your consultation, please click here.

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