Thursday, 5 April 2012
Asking the Right Question
As an extension of my role as an adjunct professor teaching a course called “The Doctor Patient Relationship,” I was shadowing one of the third-year residents in family practice for 24 hours. We were summoned around midnight to the emergency room where a woman appeared with a lump on her forehead. The young doctor took her vital signs, talked with her and expressed appropriate concern about what had happened.
The patient reported that she was on a step ladder, hanging a picture and the hammer
had slipped from her hand and hit her on the left side of her forehead where there was indeed a red, swollen bump. The doctor asked if she were in pain and whether she had any other symptoms and she responded by saying that the bump had hurt but she didn’t feel any other signs of discomfort or pain. All the vital signs checked out OK and after the doctor examined the bump closely and talked to the patient a little more, we left the room to get some pain pills and write a prescription.
Doctor Leonard looked at me while we were outside and said, "I don’t know why she bothered to come here, it’s not serious and she could have just taken some aspirin or ibuprofen and saved herself the trip." I responded by asking him if he wanted to know the real reason she had shown up and he said he thought it was because she was scared and that it might be more serious. Not a bad guess, said I, but if you want to know more, when we go back in, ask her what she’s doing on a ladder at midnight on Friday, hanging a picture.
“So,” says Dr. Leonard to Nancy Frame, “what were you doing on a ladder at midnight hanging a picture?” She looked at him, silent for a moment, and then with tears starting to flow and shaking a bit, said, “My husband just divorced me and this is the first weekend my 3 kids are with their Dad and I was all alone and feeling really bad.” She went on a bit about how hard it’s been for the past several months and she wasn’t sure how she was going to get through all of the pain, hurt and loneliness. Dr. Leonard let her express her sadness, her emotional pain, and then said he knew the name of a really good counselor if she wanted someone that she could talk to about how to cope with her struggle. She said that would be really helpful and thus that first treatment session ended.
After Nancy left, Dr. Leonard turned to me and said, “How did you know?” I said I didn’t know anything but sometimes, asking the right question will get you more information than if you assume you know that what you’re seeing and hearing is all there is to know. Take time to ask another question before concluding with your first response. See how that might change what you might have said earlier.