A Beautiful Question: Questioning in Healthcare

 

questioningBernadette 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.

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the annual physical

doctor-and-doll

The Argument: Ditch The Annual

Every year, adults face the issues of is it “time to get a check up”? Do I really want to get my annual physical? Do I need to have a checkup? Well now, even your doctor is saying the same thing! A chorus of physicians have weighed over the past several years (especially after the Cochrane Report was released). The consensus has been, for the most part: ditch the annual physical if you are healthy and have no medical symptoms.

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slow medicine – not can we afford it, but how can we not?

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The_Doctor_Luke_FildesBernadette Keefe MD

The Unease

Over the past few decades there has been an increasing disquiet among doctors and patients. Prior to the late 1970s (pre CT/MRI era) other than basic blood work and plain xrays, there was little in the way of testing for disease. However physicians were well equipped with a robust heritage of  patient bedside history-taking and examination skills. Adept physicians in elucidating a pertinent historical record and performing patient examinations were brilliant diagnosticians. Lavishly written patient narratives and exquisite physical examinations filled voluminous charts.

The late 1970s ushered in organized medicine, HMOs, regulations and abundant technological and medical advances. This potent combination resulted in a tremendous escalation in the volume and pace of healthcare. Physicians, once loved for their bedside manner and comfort (1950’s-1960’s) found, from 1980s-present that they were so rushed and burnt out they had little empathy to spare. Patients picked up on this and, coupled with little time to ask questions and (now) electronic medical records consuming their doctor’s attention, stopped feeling cared for. They stifled their questions and stopped buying into the therapies being proposed for them. (Note: Perceived lack of empathy has been shown to adversely affect clinical outcomes.)

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