Open question.
Following on from our greeting, introduction and small talk how do we transition to the dental side of things?
If we aspire to practice patient-centred care, then the tone of the interaction needs to be set early by starting the conversation with an open question – one which can’t be answered by a “yes” or “no” answer.
Although any question can receive a comprehensive answer, open questions intentionally seek longer answers, and are the opposite of closed questions. *
The aim of doing this is to encourage the patient to tell their own story and to enable as much information as possible to be obtained.
Examples that I use are “how can we help you today?” or “tell me what’s going on with your tooth?”.
Advantages;
- Gives the patient a chance to describe the problem(s) in their own words.
- Gain the patient’s perspective on the problem.
- Facilitates patient-centred care.
Disadvantages;
- TIME – likely to take longer.
- Relevance – patients may give information that rambles off-track.
- Recording information/ note-taking may be harder.
It is obviously patient dependent and the responses to an open question will vary widely across a spectrum from;
- The monosyllabic grunter who refuses to capitulate except to say, “you tell me, you’re the expert”.
- The older person living alone who when asked about their tooth proceeds to give you their life story or a rambling account of their daughter’s neighbour’s cat who had to see the vet etc. etc.
As a rule, an open question will lead to closed questions where more specific follow-up information is required based on the facts given or omitted in the opener.
Advantages;
- Useful when specific information is required – “did it keep you awake last night?”
- Fill in gaps in the narrative from the longer opening question response.
- Emergency situations where very specific information is required quickly – “exactly how long ago was the tooth knocked out?”.
Disadvantages;
- Continuous closed questions may make the consult feel like an interrogation.
- Restricts how the patient can respond.
- May go off in a wrong direction.
One more interesting concept to look out for is the interruption – there is no point in asking an open question, then tapping your feet impatiently and jumping in when the patient pauses for breath.
This will erode any good work you have done up to this point establishing yourself as a dentist focused on caring for the patient.
Beckman and Frankel in their famous 1984 study of physicians focused on the patient’s initial statement of concerns in response to the “what brings you here today?” type question.
They found that;
- Patients were provided the opportunity to complete their statement in only 23% of the visits,
- The average time to interruption was 18 seconds.
In follow-up discussion in 2017 they state serious concerns that once interrupted the patient did not raise additional concerns at the beginning of the visit – if raised at all, these issues came up at the end of the visit.
They say that “because patients frequently present with multiple concerns, and there is no evidence that the first concern is the most important … the most effective approach is to solicit all the patient’s concerns at the beginning of the visit and then negotiate what to focus on in the time allotted”.
QUESTION – how many times have you sat the patient up after a consult, the D.A. has cleared the instruments away and as the patient gets up, they ask you about another tooth or problem?
Very, very frustrating and often happens when you are already running late!!
Could this be as a result of not getting all the relevant patient information and perspective at the front end??
For me, on reflection, definitely guilty as charged …
* A closed question is one which can be answered by a “yes” or “no” or another single word.