NaBloPoMo 2019

What’s the most interesting question your doctor asks?  What effect does it have on you?

I get to ask some really fun and interesting questions of my patients.  They often come about spontaneously, then I realize how helpful they are, and I integrate them into my routine interview.

It was almost ten years ago now that I was seeing a pleasant young woman for the third time.  She had recurrent, nonspecific physical symptoms, and felt down.  She was having a really hard time at work, and it was having a significant impact on her overall health and well-being.  Around the same time I saw another patient, a young man.  He felt well overall, but was also not happy in his job.  I remember casting around in my mind, looking for a quick and easy way to quantify the negative effect of these patients’ negative work experiences on their health.  I can’t remember which visit sparked the 0-10 stress and meaning scale questions, but it was one of them, and then I repeated the questions on the other soon after.  These were my first two, unsuspecting, experimental question subjects.  On a scale of 0 to 10, how high do you rate the overall stress of your work?  That was easy, but I also had to figure out whether there was some benefit that was worth the cost of the stress.  So: On the same scale, how high do you rate the overall meaning of your work to you?  The bottom line is that we can tolerate very high levels of stress if the work is meaningful—for sustainable work, the meaning-to-stress ratio needs to be 1 or greater, and overall meaning is best at 7 or higher.  That year I realized I could create deeper, more helpful, more insight-revealing questions in my patient encounters.

My own work meaning rating rose by at least a couple integers almost immediately.

Since then I have consistently asked about body signs of stress, resilience practices, the proportions of threat vs. challenge stress at work or home.  Since I last wrote about these questions in 2016, I have continued the experiments.

By 2016 I was also using the elite athlete analogy with my patients, asking every year about habits in the 5 reciprocal domains of health (after talking about stress and meaning at work): Sleep, Exercise, Nutrition, Stress Management, and Relationships.  But after asking the same questions for a couple years in a row, both my patients and I get a little bored.  So in 2017 I went a little deeper in the relationships category.  After confirming marital status, ages and health of children, I started asking, “Tell me about your emotional support network,” because the more I am reminded of the critical importance of emotional support in our health, the less it makes sense to not ask about it directly.

With each additional set of questions, I learn more about my patients. I learn how people understand the questions—sometimes it’s totally different from my own understanding, and the conversation about the meaning and objective of my asking gives me wonderful insights into people.  Patients are remarkably open and honest in their answers, which always reminds me of the honor and privilege of my role as physician.  The answers to these questions are what allow me to imagine my patients in their natural habitats, engaging with their work and the people in their lives.  The answers provide context and texture to the other patterns we uncover in health habits, and we often come together to a better understanding of both the origins and consequences thereof.  I can’t speak for my patients, but I always come away feeling just a little more connected.  I get goosebumps just thinking about it.

This year I’m excited to introduce 4 new questions.  It started out as three.  The third one wasn’t landing quite right initially.  I wasn’t asking what I meant, and I couldn’t quite articulate what I was after.  So I experimented with the wording until I got to the current state:

1. In the coming year, what do you see as the biggest threat to your health?
2. What is the biggest asset?
3. Having answered these, how does this affect your decision making going forward? …And other iterations I can’t remember anymore
4. One year from now, when we meet again, what do you want to look back and see/say about your health, relationships, and whatever else is important to you?
5. (then the corollary question that occurred organically once and I then incorporated–) In order to make this vision a reality, what support do you already have or need to recruit?

I have asked these questions since July.  I always think to myself how I would answer for my patients, based on what I know about their circumstances, habits, and biometrics.  About two thirds of the time, our answers are the same.  Patients seem to receive them well, too.  One asked me to email them to him, so now I offer to email them to everybody.

You might imagine that I think these questions make me a better physician.  That may or may not be true.  All of these questions make me better—a better, more self-aware person—because I also ask them of myself.  What is my meaning:stress ratio today?  This week?  This year?  I assess the threat/challenge ratio of my own life stressors, especially the acute ones.  I have had the same body signs of stress for many years, but in 2019 I may have developed a couple new ones, darn.  What’s the biggest threat to my health?  My hedonist impulses, no question.  The biggest asset?  My Counsel—those best friends and confidants.  What is my vision for my health a year from now?  I only answered that for myself a week ago (and I’ll keep it to myself, thank you).  And what support do I have/need?  I’m still working on that one!  That I don’t already know the answer to this one surprises me—I assumed I knew, but when I sat down to think about it formally, I realize that this may be the missing piece that holds me back from achieving some of my personal health goals.  HUH, how fascinating!  Did I not just write about how I question some of my patients’ ‘Lone Ranger’ method of self-care?  Well hello kettle, I’m pot!

Now, off to ponder some more, yay!