Questions, Questions — Who’s Got the Answers?

It seems these days there’s a questionnaire for everything.

In place of our old Review of Systems (or perhaps in addition to), there are now multiple screening questionnaires and symptom-based tools that patients can fill out in advance of their office visits.

For a while there, our electronic medical record was sending out a complete Review of Systems for patients to check off at home all the symptoms they were having, but this proved to be pretty onerous to work with, and patients generally did not like it or did not complete it. Now, it seems, we’re moving away from this, and towards a series of disease-, specialty-, and symptom-directed questionnaires that patients can fill out in the comfort of their own homes, on their phones or laptops or tablets, with their feet up on the couch. What we haven’t quite figured out yet, even though many of these have already started to roll out, is the best way to use these, and the situations in which they should be sent.

There are questionnaires for asthma, questionnaires for substance use disorders, questionnaires for symptoms of an enlarged prostate, questionnaires for sleep apnea, questionnaires for multiple mental health issues, and on and on, covering many disease entities and many of the symptoms that our patients have, and the conditions we are managing (and many we are not). Getting this right, figuring out how often to do this, when to do it in advance of an appointment, for which type of appointments, and who should get the results and then deal with them, is a whole other kettle of fish.

I’ve written before about the information overload from remote patient monitoring, with patients sending in huge dumps of data collected on their health conditions, such as their weight and blood pressure for heart failure and hypertension, or their fingerstick glucose readings for diabetics, or their oxygen saturation, temperature, and symptom diary in COVID-19.

While it’s true that having no data about our patients is incredibly frustrating, we have to find that delicate balance with just enough — only the information we need to help make a good medical decision about managing care. If there’s too much information coming in about any one condition, or an overwhelming tidal wave of information about multiple conditions, it’s unlikely that we’re ever going to be able to catch the signal for the noise.

If every time a patient comes in to see us in primary care, we are front-loaded with dozens of data points and scores of questionnaires that the patients filled out in advance, we’re never going to be able to manage them while they are here in the office with us for their (very brief) office visit. Again, I’m not saying that this information isn’t important, but we know that we only want to screen for things that we can do something about, and far too often we are being asked to deal with answers to questions that we can’t really help our patients move forward on.

One would not do mammograms if there were no breast surgeons or oncologists around, and no point in doing colonoscopies if you have no way to remove or treat what you find. Screening for the social determinants of health is only useful if we are then given the resources to give to our patients to help them overcome issues such as food and housing insecurity. And screening for mental health issues only truly makes sense if we have a cadre of colleagues standing by to provide the mental healthcare that our patients so desperately need, especially as we have seen depression and anxiety and PTSD so terribly exacerbated by the pandemic we’ve all been going through.

So while it’s really cool to be able to send patients pre-visit planning information through the portal, we definitely do not want to open up the floodgates and just ask every patient every question in advance of the visit, especially if we don’t have the resources to help manage and treat what comes back to us. But give us those resources, give us everything we need to take care of our patients, overwhelm us with support, resources, and community care, and we are ready to take up the mantle of dealing with all of this.

Question everything.

Fred N. Pelzman, MD, of Weill Cornell Internal Medicine Associates and weekly blogger for MedPage Today, follows what’s going on in the world of primary care medicine from the perspective of his own practice.

Last Updated September 20, 2021