Why we don't force patients to answer multiple choice questions about their symptoms

Dr Ben Brown
Dr Ben Brown
  • Updated

Many online consultation systems force patients to answer lots of multiple choice questions (MCQs) about their symptoms. They then direct them to A&E or 999 if they give a particular answer.

PATCHS is different. We allow patients to write about their symptoms as free-text answers to open ended questions using their own words. If switched on, Topic AI Questions can ask patients further questions based on the clinical topic of their request, and Signpost AI can signpost patients away in case of an emergency, but this is done on the general content of their request (not specific answers) and patients can choose to not answer or override signposting advice.

Here are the reasons we do this:

  1. It's like a traditional GP consultation. Our open ended questions are typical of the ones GPs and other primary care clinicians use. They include symptom descriptions but also ideas, concerns, and expectations. Free-text responses make it conversational - clinicians want to hear patients describe their problems in their own words. This is more natural than mechanical yes/no answers to MCQs.
  2. Patients prefer it. Patients don't like MCQs in online consultations because they're difficult to understand, long-winded, inflexible, and hard work. They can be asked 10s of questions for a simple complaint, many of which are completely irrelevant. Patients will often give up on MCQ online consultations halfway through and call the practice instead, which completely defeats its purpose.
  3. It's less work for GP practice staff. When patients fill out MCQs in online consultations, it increases workload for staff because: 1) there's lots of questions and answers to read (many of which are irrelevant), 2) despite asking lots of questions MCQs often don't provide sufficient detail about the patient's request so you end up contacting them for further information anyway by phone, 3) you are responsible to further assess any irrelevant symptoms they say they have, 4) patients can 'game the system' and answer MCQs in a particular way to get what they want e.g. a face-to-face appointment for a condition that could be managed by self-care.
  4. It's safer. 1) When patients describe their problems and request in their own words they are more expansive. It provides a richer narrative than just one-word answers to MCQs. This can provide more relevant information to the patients' problem, meaning you can make more informed clinical decisions. 2) If patients are forced to contact A&E based on their answer to an MCQ, then can just go back and change their answer - meaning you get an underplayed picture of their symptoms. 3) Online consultation systems that use MCQs are attempting to ask every possible question for a patient's complaint so you don't have to. This can lead you to rely on the system - though there will always be times it will get things wrong. 

You can read the research evidence for the above claims our 'research evidence' section.

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