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A question sheet to encourage written consultation questions
  1. Cliff Cunningham, visiting professor of applied psychology
  1. School of Health, Liverpool John Moores University, 79 Tithebarn Street, Liverpool L2 2ER, UK
  1. Richard Newton, consultant paediatric neurologist
  1. Royal Manchester Children's Hospital, Pendlebury, Manchester M27 4HA, UK
  1. Dr R Newton

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The aim of quality improvement reports is to answer the following questions:

  1. What was trying to be accomplished?

  2. What makes a change an improvement?

  3. What was the mechanism for change?

  4. What lessons have been learnt?

  5. What are the next steps?



  • Interviews with parents and children attending a hospital paediatric neurology clinic indicated they had difficulties in asking questions during consultations.


  • To set up a process to enable parents and children to get the information they wanted.

Background and setting

  • Two paediatric neurology clinics in separate hospitals in Greater Manchester, UK with a similar client group run by one consultant.


  • Various styles of question sheets were evaluated. The one that was chosen asked patients to write down questions and hand these to the doctor at the beginning of the consultation. Question sheets were given to all patients attending one clinic over a 13 week period.

Strategies for change

  • Use of sheets: number of patients taking or refusing a sheet, with reasons for refusal, were recorded. Doctors noted those who handed questions sheets to them

  • Satisfaction with sheets: patients completed a short feedback form after the consultation

  • Effect on consultations: evaluated through interviews with the doctors.

Effects of change

  • In total, 66 (41%) of the 162 patients offered the sheet declined: 14 had already prepared questions; eight being seen for the first time felt they did not know what to ask. Seventeen had used the sheet on a previous visit and did not need it again; 19 gave no reason; the rest said they had no questions. Seventy six (47%) patients produced a sheet in the consultation. Of those using the sheet, 64 (84%) liked it and 61 (80%) found it useful. Fifty two (68%) wished to use it at future consultations. The doctors reported that through questions …

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