Encouraging Patients to Ask Questions

THE FOCUS OF AN ONGOING EFFORT IN HEALTH CARE quality improvement is to encourage patients to ask questions during their care. In September 2011, the Agency for Healthcare Research and Quality (AHRQ) launched the Questions Are the Answer campaign (TABLE) and has used $20 million of donated marketing outreach toward building patient engagement through asking questions (Farah Englert, AHRQ, November 15, 2012, written communication). In 2002, the Joint Commission created Speak Up, an initiative that promotes patient involvement in care and emphasizes the importance of asking questions (Table). Encouraging patients to ask questions makes sense; it has the potential to enable shared decision making between patients and physicians. As a result, patient adherence may improve, patient satisfaction may increase, and patients may be more likely to receive care that is in accordance with their values and preferences. While patient engagement is unproven and potentially inappropriate as a safety net for catching medical errors, it may be a valuable tool for facilitating communication that empowers patients. But the barriers that prevent patients and physicians from meaningfulquestion-and-answerexchangesaresubstantial.Simplyencouragingpatientstoaskquestionsandprovidingexamples are not enough. This Viewpoint describes these barriers and presents suggestions for how they may be overcome.