Since seeing a new patient for the first time last week I have been thinking a lot about what is the right and what the wrong way of saying things. Twice I found myself asking a question awkwardly or saying something clumsily, but realised this in time, and quietly re-phrased what I was saying in a way that satisfied me.
The first time was when I asked my patient, “Are you happy with your life?”, and realised immediately that this was not the right way to frame the question. I then changed it quickly to, “How happy are you with your life?” Thinking back on this, I realise that my initial question gave my patient only the option of saying “yes” or “no”, either reply being unlikely to reflect the truth, since nobody is either truly only happy or only unhappy about all aspects of their life. Such a black and white question makes it easy only to respond with a black and white reply, leaving no room for all those grey areas in which we live our lives most of the time, sometimes happy, sometimes unhappy, but never either of these all the time.
The second time was when my patient told me that she was going back to Ireland to see her family for the first time in 4 years, and I found the words, “How lovely”! How exciting for you!”, coming to my lips, before I bit them off in time, and asked instead, “Are you looking forward to this or are you dreading it?”. My first question was like one of those meaningless interchanges we litter our social life with and which mean absolutely nothing, such as, “How are you?”, “I’m fine”. It would effectively have closed the door on any hope of hearing how my patient actually felt about seeing her family after such a long time. Why had she left it so long, after all, if it was an easy relationship? Ireland, unlike Australia, is easy to travel to.
On such little shifts in the way we frame our questions and responses to our patients often hangs the development of a good or tricky relationship with our patients. I still myself remember the time when a friend told me that she was surprised that I had reacted as I did to something that had happened, and said, “I can’t understand why you didn’t…….” That effectively stopped me from telling her anything more about myself, because I felt I was regarded as a bit odd for being as I was. Instead of being offered an implied criticism, what I would have responded well to would have been to have been asked why I did what I did.
And we must make sure that our engagement with our patients, too, gives them the freedom to tell us truly why they did what they did and felt what they felt. We must never assume we know the answers to this. Only our patient does.