The Art of Asking

Most people know from experience or through intuition that there is a right time and a right way to ask important or sensitive questions. You don’t usually just blurt out requests for raises or marriage proposals, for example.

In many areas of life, knowing when and how to ask difficult questions is viewed as an extremely valuable skill, for example in criminal investigations and in journalism.

In some cases this kind of skill can even make you a media star: Interviewers like Barbara Sawyer, Oprah Winfrey and Howard Stern are more famous and better paid than most of the celebrities they engage in intimate conversations in front of their national or world-wide audiences.

This year, the US presidential debates have been said to require unusual savvy from their moderators and their performance may even affect the outcome of the election.

Why is it, then, that in health care so little value is placed on when and how you ask sensitive or important questions?

In healthcare, we are constantly told that we must ask the most personal and intrusive questions of anyone who walks through our doors before we even ask what brings them to the doctor in the first place. And, unlike other interviewers, we must use “standardized” and “validated” questionnaires, because our work isn’t like other forms of fact or truth finding; our purpose is to collect data and to apply statistically proven interventions. No room for tact or finesse here.

When Autumn, my nurse, checks in a new patient, each one has already answered questions about gender identity and gender at birth. Autumn, along with doing the usual vital signs, has to administer a depression screening, inquire about alcohol habits and smoking, along with readiness to quit. For people with a BMI over 30, she has to ask what they are planning to do about it.

In many practices, the patient’s “History of Present Illness” and “Review of Systems” are asked and documented into obtrusive computers by freshly graduated medical assistants with limited medical and psychological training or experience. But that’s okay, because we use validated instruments and people always open right up and tell us the truth, and they always present their most important symptoms to us on a silver platter, the thinking goes. So, therefore, professional skill and experience may be valuable in rare cases, but there is just too much variability in that.

So, let’s imagine that our mandates applied in other areas of life:

What if criminal investigations were conducted by administration of nationally established “Criminology Assessment Protocols”?

What if lawyers could only use validated questionnaires and weren’t allowed to cross examine witnesses?

What if all celebrity interviewers could only ask the same set of questions?

What if the presidential election was determined by having our citizens vote for candidates based on their answers to a standardized and validated “Presidential Fitness Inventory”?

No, that would seem ridiculous, most people would say. So why is that the way we have to ask questions in medicine?

Unlike detectives, journalists, lawyers, bureaucrats and politicians, doctors just don’t know how to ask the right questions to figure things out.

2 Responses to “The Art of Asking”

  1. 1 meyati September 27, 2016 at 12:26 am

    Unlike detectives, journalists, lawyers, bureaucrats and politicians, doctors just don’t know how to ask the right questions to figure things out. ha, ha, ha

    Are you depressed? NO, Do you have suicidal thoughts? NO- You have an incurable head cancer-Now are you sucidal? You should have counseling No. I downloaded on a French doctor- a former boyfriend how much it upset me. How the successful radiation made the incessent droning painful. It made my BP go way up. Steve told me that I had situational depression, and they were depressing me.

    Would you believe that a recent nursing tech helped stop this miserable questioning for me. She looked 13 years old– and she said– Ijola She’s from Spain–why are they molesting you about these things. You are 70, and you are alive–Why are they acting like you don’t know your body at this age. She did something–

    Today I saw my PCP-check in–Do you have a co-pay? Yes. Will you sign permission for treatment? Yes and I signed Have you been outside of the US in the last 3 months? No

    I got in the office. Have you fallen in the last 30 days? Hell no Do you feel safe? I think that I give them nasty glaring looks- YES-YES-YES!!

    OK–I’m putting down NO for everything else. Oh thank God.

    I went in during the Olympics-and they asked me if I planned on going overseas in the next 12 months–that made me mad -Then they said take a seat—I said– What? You aren’t asking me if I’ve been to Miami or plan on going to Miami. Now that would be medical planning- knowing to watch me and my family.

    I guess they talked it over, because now they ask everyone if they are going to Miami and the tropical US.

  2. 2 Lisa September 27, 2016 at 8:18 pm

    My surgeon is a breast specialist. That is all she does. The only other surgery that she does is the placement of ports for chemotherapy. On the form that I fill out for her every year is a question that asks if I have ever been diagnosed has having hemophilia. Every year I answer “How many female hemophiliacs have you ever had visit your office? And, what is the percentage of male hemophiliacs that also develop breast cancer?” The question is a waste of space on the form.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.



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