I am an engineering graduate. My rigorous education has taught me that when presented with a problem, I should systematically narrow down solutions to figure out the best possible one.
During my second week of medical school I had my first standardized patient encounter. I felt very pleased with myself when I walked out the door after having asked the patient specific questions about her foot pain and been rewarded with the details of her worries. I figured that since she was complaining about her foot, I would fix the problem after I obtained the necessary skills. That’s how it works right? It’s how my engineering education had taught me to think.
But I could not have been more wrong. The professor quickly reprimanded me for not asking the question of why. Why was my patient worried about her foot pain? I personally thought that was none of my business; it isn’t normal to ask personal questions, I believed. And so, at the time, I shrugged my shoulders and made note to prod a bit more next time.
During my next standardized patient encounter, I remembered to ask why. Why was my patient worried about her hip pain?
She told me she was concerned because her mother had needed hip surgery a few years ago. Okay, I thought, this time I nudged enough to obtain more information without getting too personal about her family. Wrong again. I was told I had still had not delved properly into my patient’s emotional story. My professor told me to ask more why questions. Why did your mom go through hip surgery? How did she recover?
Dumbfounded, I asked, “What gives us this right to ask something so private?”
He simply responded: “The white coat.”
As a physician, we are honored with the right — and the duty — to not only prod the patient for more information, but also to courageously break down the barriers that define social nicety. We were expected and judged on our ability to ask a series of intimate questions. To ask why.
During my first-year clinical experience, I was asked to obtain a patient’s history. I asked her to tell me in her own words about her recent diabetes diagnosis. With a confused look, she asked me if I didn’t want to know about her lab values or her medication immediately. She later told me she deeply appreciated my style of questioning, my willingness to listen and no-rush attitude. She talked about how she loved to eat.
Hmm, I thought, this was a good place to practice my prodding. As if the floodgates had opened, soon she was crying and telling me that she was feeling severely depressed because diabetes had taken away the last thing she loved. Luckily the doctor came into the room at that time, and she was able to talk to her and refer her to a psychiatrist.
It is always difficult to walk into a complete stranger’s room and be comfortable enough to ask such personal questions. Often there are many differences in education, personality and culture that muddle relationships and make it hard to break barriers.
That day I realized how important it is to obtain as much information as possible from the patient and to form a connection with another human being. As a student doctor, I have to learn to gauge whether it is best to let the patient break the barrier, open their floodgates, and swim through their feelings, or whether I should throw them a rope, ask them focused questions, and tug them back to the shore. When should I ask why? Regardless of the circumstances, always listen to the patient because they are the ones telling us the diagnosis. And never be afraid to ask just one more why.