In my previous article, I talked about using too many options for patients. I compared the 0-10 scale to the menu at The Cheesecake Factory Restaurant.
The same thing happens when asking patients about the timing of each symptom. I used to ask each patient if their pain was “constant or on and off.”
Patients Love to Say Constant.
When I would reply with, “So you feel this pain 100% of the time you’re awake?”, many of them would say, “Well, no.” I’ve had patients actually think that if they felt the pain 60% of the time, that was constant.
Every Waking Moment
Now I ask patients if they feel each symptom “every waking moment.” That seems to be much more understandable to patients. If they say “yes” to that, I feel comfortable documenting “100% of the time.” If they say “not every waking moment,” I’ll reply with, “Do you feel this symptom half the time, more than half or less than half of the time?” If they reply with, “Half the time,” I’ll document 50% of the time. If they say, “More than half the time,” I’ll have them choose between 55% and 95% of the time. In other words…
I’ve shortened the menu.
I only go through this on the first visit. After that, in my EMR, I can see what the metric was on the previous visit and I ask the patient if it’s different today, and document the new numbers. That takes just a few seconds.
What about the functional outcome questionnaires?
Many doctors don’t like giving their patients functional outcome questionnaires because the patients hate them and get mad at the doctor for making them do them. The problem is that you’re giving them…
The Wrong Questionnaires
Many doctors use the Revised Oswestry for patients with low back pain and the Neck Disability Index for patients with neck pain. I haven’t used either of these questionnaires for about 20 years. Why not? Each questionnaire has 10 questions, but each question has 6 different options. That’s a total of SIXTY OPTIONS per questionnaire. It’s too much for many patients, and they tend to zone out by question 4 and their answers tend to make no sense. I’ve been using the Bournemouth Neck and Back Questionnaires for about 20 years, and the patients appreciate them. Each questionnaire is only 7 questions, with just one option per question. It takes an average patient less than a minute to complete the questionnaire.
The bottom line is, we need to document these relevant metrics, but we need to make it as easy and fast as possible for our patients to give us accurate information.