There are two ways to learn what is really going on with another person who seems to be struggling: by asking them or by waiting for them to tell you. It turns out that when care providers are proactive and ask first, they are also more likely to help others cope with their challenges.
Our findings are in a new paper in a new paper in BMJ Quality & Safety. Specifically, we tracked how health assistants and physicians reacted to verbal cues that something in a patient’s life may be affecting their health care (what we call “contextual red flags.”) Providers who asked about these contextual red flags were more likely to act on what they learn than when their patient volunteers the information without being asked. For instance, if a patient has lost control of his diabetes (a contextual red flag) because he started working the night shift which has disrupted his diet, the physician is more likely to adapt the care plan if she learns about the life change by inquiring rather than having to be told.
How much more likely you ask?
This is the kind of phenomenon that you can only discover by directly observing patient-provider interactions. We found this pattern by reviewing audiorecordings made during three different sets of encounters.
Two sets were recordings of visits between patients and physicians (209 visits from our research, and 1183 visits from a quality improvement project focused on improving contextualization), and one set was recordings of 96 telephone calls from clients to Accolade health assistants.
(Accolade is a novel company that contracts with employers or payers to provide telephone health assistants to aid employees/members with healthcare and claims needs. As you can also see from the chart, their health assistants do very well at contextualizing their advice – so much so that with their higher overall contextualization rate, 96 calls is not quite enough to call the difference in the chart significant using Accolade data alone. Full disclosure: our company, I3PI, consults for Accolade and had helped them study contextualization several months before we got the idea for this paper).
We found that value of physicians or other care providers actively asking patients about red flags that lead them to reveal relevant contextual information is not simply in the context that is revealed. The act of asking is associated with a greater chance that the context will actually be used to tailor plans of care. This could be because providers who are attuned to the importance of context do more asking and more tailoring than those who are not, or could be because asking and getting a positive response makes the context more salient (or both). Of course, it could also mean that providers only ask about context that they already know to how use.
Our take-home message: Providers should be encouraged both to ask more about potential context and to listen more when patients reveal it themselves.