A Good Question
My mom used to let up on the brakes at a stoplight while it was still red, but (like magic, to me as a seven-year-old) it always turned green just as she did that.
“How do you know the light is about to turn green?” I asked from my vantage point in the back seat one day.
“I watch for the amber on the light for the people going the other way,” she said, “and that way I can tell it’s just about our turn.”
That memory is so vivid, I think, because I learned two things. First: my mom observed things beyond the obvious. I’d never thought to do that. Second: she somehow knew exactly what I was getting at with my question. This led me to ponder the power of a well-asked question—a concept which followed me into my work both as a journalist and as a paramedic. Journalists and paramedics must gather extensive information, often quickly, in order to do their jobs. I like to joke that by now I can ask darn near anyone darn near anything. It’s what I do.
A successful interview is like opening a treasure box of information. A good question gets to the point in a way that encourages the recipient to be both willing and able to give me the answer I seek. The skill includes:
– finding the best word choices. For example, “Ok if I take your blood pressure?” doesn’t fly well with toddlers, who don’t like things taken from them. “OK if I measure your blood pressure?” works better.
– using appropriate body language (especially tone of voice). Towering over someone works, sometimes. And sometimes, it’s better to hunker down and not seem so imposing.
– timing. For example, it’s best to ask a young female with the possibility of ectopic pregnancy as a cause for her abdominal pain, “Are you sexually active?” only after the patient trusts you! It’s best to inquire about domestic violence once the patient feels safe.
One of my first questions at an emergency scene is, “what’s your name?” Once I know a person’s name (and offer mine), we transition from the generic “911 people” to something more personal. This simple act can relax tension and instill confidence. Also, using the person’s name frequently as you develop rapport demonstrates that you are listening. This builds trust. Reduced tension, confidence in your skills, and trust in your intentions will do much for keeping any emergency scene safer and your care effective.
Much of the skill of asking good questions rests with weaning yourself from the lists so laboriously memorized in training of the information you need to know for a given medical problem. It’s as if there’s a mental “Rolodex” to each potential problem: chest pain, seizures, diabetes, stroke, etc. Each has its unique set of questions. It’s important to be thorough—but with experience, a good interviewer will stop relying on the rote list. Instead, the order of questioning becomes organic, building on the information as it is provided even if it’s obvious the patient didn’t read the textbook. If you arrive and hear, first, that “my nitro isn’t working!” for a patient with chest pain (but the question about medicines is far down the list), you can acknowledge what you already know once the time comes to ask the question: “in addition to the nitroglycerine, do you take any other medicine?” This demonstrates that you are hearing the patient—and few things in our toolkit can build confidence better than that.
Nowadays, I serve as a first responder. Helping the patient (and the family) have a “green light” start to involvement with the medical system can’t hurt—and this can be done by asking good questions in a sensible manner.