Asking the Right Question Can Reveal the Root Cause of a Symptom Recently I was in the office of a physician specializing in pain management. One patient had pain in her knee. In the interview process, she talked about various reasons for the pain: pain in her foot, knee, neck, etc. The physician asked her, “How are things at work?” She responded that everything is fine there. She then was asked, “Do you think your back pain might be related to your job?” Her answer was no. This was a classic example of how medical science works. One physician was looking for possible causes. The patient’s answer gave her an opportunity to consider the possibility of a back condition that could be caused by her job and could potentially provide an answer for what she felt caused her knee pain. The fact that she didn’t have to wait for results on some test — she was being told something about herself and the cause of the knee pain. The patient was receiving some reassurance, in the form of possible validation of her experience, from being given a diagnosis, as well as guidance in what to do in terms of working with her pain. The patient didn’t have to wait for the diagnostic test to confirm what the physician was telling her in the interview process. When patients complain of pain, it’s better to ask the right question first and then follow up with a “Yes/No” question. This particular patient came in for treatment and the diagnosis was spinal stenosis. When I first heard that, I didn’t know what it meant, and so I made a note to ask her. I wanted to know if she’d heard the diagnosis from someone else. Turns out she hadn’t. I also wanted to know what she felt she could do about this diagnosis. She said she could work from home, although she didn’t want to take time off and felt that if she took time off she’d miss her work. She did have pain in her lower back, but the severity of the pain did not seem to match the level of radiating pain she described. We worked together on this issue of how to manage the back pain, and she left with a plan that included stretching exercises and some pain medication, such as Ibuprofen. She did not have a surgical procedure performed. Sitting in the office, it occurred to me how important it was that she hear this diagnosis and to make sure that she understood it, so I asked her again how she felt about it. She had a few things to say. She didn’t like the fact that she couldn’t stand up straight when she lifted objects. She did like that she could sit in her car for a long time. She enjoyed gardening. She also was bothered by how other people reacted to her walking “too fast.” She went through a litany of these things, all the while she was demonstrating symptoms of the condition. From her perspective, she was trying to go through her day without pain, but the pain was returning every time she walked, stood up, lifted objects or sat for too long. It was an “on and off” process. This woman’s story is a great example of how to ask the right questions. It’s not that the right questions will give you the answers that you want. But questions can be used to clarify issues, highlight problems, and help patients to define their needs. In this case, she didn’t know how she felt about the diagnosis, and so I asked her. The patient is not a medical expert, so she could not accurately state how her back feels or if she is having problems with back pain. We talked about the fact that we were talking about “back pain,” and she agreed that “back pain” did not sound like what she was experiencing. The fact that I had asked her those questions helped her to better describe her situation and her symptoms, to better understand the problem and potential answers. This story is also a great example of how a physician can combine medical knowledge with a focus on the patient’s self-exploration to move toward answers that fit the diagnosis. The process of medical diagnosis is complex and requires physicians to understand what are often complex medical issues. This story is one example of how to bring insight from a patient’s perspective into the medical process. The patient’s experience can be valuable in a twofold manner. On one level, the physician can listen for things that the patient might be saying in a way that reveals potential answers to the medical problem and on a deeper level, the patient’s experience can help the physician find answers that are helpful and meaningful to the patient. This is part of the value of having multiple voices in the examination of the patient. In this case, both the physician and the patient together came to an understanding of what it means to have a diagnosis of spinal stenosis and how the symptoms described by the patient might be treated. The doctor didn’t tell the patient what to do. She provided the patient with a medical diagnosis and the basis of that diagnosis and information that could be used to create an action plan. Many people do not have the luxury of going to a physician, particularly for long periods of time. Therefore, it is important to learn how to listen to your own body to learn what works and what doesn’t. We need to be smart about our diagnosis. Sandra Zellmer-Bruhn MD The goal of this blog is to promote ideas in the areas of child development, parenting, education, health and mental health, especially as it relates to improving children’s mental and physical health. It is about taking control and responsibility for your own and your child’s well-being. 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