Bernadette Keefe MD
A person skilled in the art of questioning is a person who can prevent questions from being suppressed by the dominant opinion. – Hanz-Georg Gademer
It was just after New Years 2015 when an an article by Warren Berger entitled “Forget Resolutions, Whatʼs Your Beautiful Question” caught my eye. In it, the author (see his book “A More Beautiful Question” 2014) suggests that instead of making New Years resolutions (ie: aspirational statements) we should formulate our own ʻbeautiful questionʼ. With questioning firmly top of mind, I started noticing game-changing endeavors that began with one fresh, simple question.
Questioning: MD and Patient
An example in the healthcare field, of relevance to all of us, is the story that Dr Leana Wen (author “When Doctors Donʼt Listen”) relates of her first experience sharing a medical record with a patient. She was a 4th year medical student at the time [I think this is significant, by the way]:
“The woman was sitting on a gurney in the emergency room, and I was facing her typing. I had just written about her abdominal pain, when she posed a question Iʼd never been asked before “May I take a look at what youʼre writing”.
The rest is history. From then on Dr. Wen shared clinic notes with her patients, went on to speak about this experience, and co-authored her widely read book. A courageous patient stepped out of ʻprotocolʼ to pose a question to an obliging and receptive 4th year medical student, who equally stepped ‘out of protocol’. Thus creating the core of smart change, innovation, and true progress.
In our fast paced world, the time and space afforded to questioning is rare. Despite the agreed value of questioning, in the pursuit of knowledge and understanding, questioning in workplaces is usually discouraged by many leaders and CEOs. We are losing our power to question, and, along with it, our questioning skills. We were not always like this; consider the questioning of children.
Questioning: As A Child
In Warren Bergerʼs book, “A More Beautiful Question”, he recounts a delightful episode written by the comedian Louis C.K. where the comedian tackles the barrage of questions typical of a young child.
“You canʼt answer a kidʼs question, they donʼt accept any answer. If you do try to answer you only end up caught in an endless circle of Why questions: “It starts out innocently enough -Papa,why canʼt we go outside? but eventually (he has to ) explain why itʼs raining, why clouds form, why he doesnʼt know why clouds form, why he didnʼt pay attention in school…..etc”
The free wheeling questioning of young children morphs all too soon into the reticence of adolescence and the conformity of adulthood. Gone is “questioning with abandonʼ, particularly the type of open questioning considered part of the beginners mind (coined “neotony” by Joi Ito.); a state where one has not labeled and categorized everything, a pre-silo state.
Punch, 1906 (from my paternal grandmother’s scrapbook )
Questioning: In General and In Healthcare
For adults, with the overwhelming pressure to find answers ever present, the concept of pondering ʻthe beautiful questionʼ seems like a luxury. However, Berger argues the opposite; the pursuit of the right questions and the process of strategic questioning is precisely where we need to spend our time. He quotes Dan Rothstein of the Right Question Institute (RQI):
“Questions are flashlights that shine a light on where you need to go”.
Berger quotes another avid questioner, the social activist Frances Peavey: “a good question is like a lever used to pry open the stuck lid on a paint can.”
These metaphors are well suited to the pressing issues of healthcare where the potential value of zeroing on the right questions could be huge. The challenge of a number of seemingly intractable issues in healthcare include: need for major culture shift, stakeholders at cross-purposes, the looming chronic disease “epidemic”, the issue of caring for an aging population, and balancing technology & staggering cost challenges – indeed, this can feel like a stuck paint can.
Once agreed on the inherent value of good questions and strategic questioning, what is known about accomplishing this? Berger quotes Gregersonʼs study of business leaders and found those who were open to questioning had:
“…an unusual blend of humility and confidence – they were humble enough to acknowledge a lack of knowledge and confident enough to admit this in front of others”.
Such a combination can be hard to find in the classic hierarchy of medical care. However, with an urgent need for close partnerships between MD and patient to achieve optimal outcomes through shared decision making, those that understand both the importance of questioning, and, of validating the questioner, will have the most success. Such validation requires patience (to focus and listen), mutual respect and trust, absence of fear, and a desire for mutual understanding.
Depending on the circumstances we can ask open ended type questions; the how, what, why questions, or more defined (yes-no) type questions. The Right Question Institute is a superb resource for understanding how to design and ask the questions of most value. Questioning patients are not pestering (their physicians), but rather, doing the job of an engaged patient. The best physicians understand this. If, as a patient, you find your questions are not getting answered, it may be time to seek a second opinion. I would refer all to this resource: The Right Question-Effective Patient Strategy (RQ-EPS) which makes it possible for all patients, no matter their level of education, to more effectively ask questions, and do the following:
- partner with healthcare providers
- participate in decisions that affect them
- navigate the healthcare system
- take more ownership of their own health
Conclusion
As participants in healthcare delivery, whether requesting or needing healthcare, or providing healthcare, the ability to ask, and elicit questions, is essential. It must be our collective goal to carve out the time and space for questioning.
BK
Resources
“Forget Resolutions, Whatʼs Your Beautiful Question”, Warren Berger, Fast Company, January 13 2015, http://www.fastcodesign.com/3040821/forget-resolutions-whats-your-beautiful-question-for-2015
“Neoteny”, Joi Ito, December 15 2009, http://joi.ito.com/weblog/2009/12/15/neoteny.html,
“Did Socrates Get it Wrong?”, Dan Rothstein, TEDxSomerville, May 19 2012, https://www.youtube.com/watch?v=_JdczdsYBNA
“The Right Question”, Dan Rothstein and Luz Santana, ASCD, October 2014, http://www.ascd.org/publications/educational-leadership/oct14/vol72/num02/The-Right-Questions.aspx
“Questioning or Pestering Your Doc?”, Frances K Howell, MedShadow, September 29 2014, http://medshadow.org/first-person/questioning-doctors/,
“Designing Effective Projects: Questioning the Socratic Questioning Technique”, Intel Education Initiative, 2007, http://www.intel.com/content/dam/www/program/education/us/en/documents/project-design/strategies/dep-question-socratic.pdf, accessed January 30 2015
“The Art of Effective Questioning: Asking the right question for the desired result”, Irene Leonard, http://www.coachingforchange.com/pub10.html,
“When Patients Read What Their Doctors Write”, Leana Wen MD, Reader’s Digest, February 2015, http://www.rd.com/health/wellness/patients-read-what-doctors-write/print-view/,
“What’s Most Important to You? The Only Question that Matters.”, Kristin Baird, January 16 2015, http://baird-group.com/blog/whats-most-important-to-you-the-only-question-that-matters,
“Lessons from the American Public Health Association Conference”, Rebecca Howe, The Right Question Institute, December 18 2013, http://rightquestion.org/blog/lessons-american-public-health-association-conference/,
“Right Question – Effective Patient Strategy”, The Right Question Institute, http://rightquestion.org/healthcare/,
“Terrie’s Story”, QIO Program, July 21 2014, https://www.youtube.com/watch?v=6xfARq-jCXs&feature=youtu.be&app=desktop,
“If You Question Authority, You are Mentally Ill – Report Finds”, Tyler Durden, Zero Hedge, January 22 2015, http://www.zerohedge.com/news/2015-01-21/if-you-question-authority-you-are-mentally-ill-report-finds,
“Questions to ask your healthcare team”, Canadian Cancer Society
Bernadette Keefe MD 