This article, part of a regular column called "Total Patient Care" in On Scene magazine, appeared in October, 1991.
Have you ever asked a question and then received an answer that made you wonder what the other person heard? The response seemed to have little or nothing to do with the information you were seeking. What in the world was the other person thinking, to give a response so unrelated to what you asked?
There are numerous reasons why people do not receive straight answers to their questions. The failures of interpersonal communication far outnumber the successes--particularly when either person is distracted or stressed. These are, of course, the usual conditions of rescue work. Whereas it may be tempting to blame the inappropriate response on the other person's poor listening skills, consider for a moment that your questioning skills may need improvement.
A well-phrased question yields accurate, thorough and complete information. The following five elements for building a good question could improve your batting average when it comes to quickly getting the information you need.
A good question suits the patient's interpersonal needs. It's easy for history-gathering to become routine and to forget that each individual patient is a unique case. In your own mind, you 've already categorized and organized the information you're seeking--that's human nature. The flexible rescuer will, however, learn to vary the order of the questions and their wording to meet the needs of the patient. For example, some people respond best to simple wording; others are more sophisticated allowing you to use different words to be more precise. Also consider the circumstances: Someone in respiratory distress needs questions that can be answered in one or two words, while a longwinded patient must be kept on a verbal short rein in a way that still maintains rapport.
A good question is unambiguous. Ambiguous questions are those that are open to several meanings or interpretations. A person with good interviewing skills asks questions in a way that consistently generates appropriate responses, regardless of the circumstances. In rescue work, this requires sensitivity to others. Many of the strangers we meet think on a different level than we do; questions must be phrased very carefully. This requires flexibility on the part of the questioner, both in terms of work choices and the nonverbal behaviors that accompanies delivery of the questions.
A good questions is well-timed. When strangers come together, particularly in a crisis, the challenge is to build trust and rapport rapidly. After all, rescuers have to touch people in private places and ask personal questions. The rescuer learns to listen closely to each individual in order to know when sensitive questions are most likely to receive honest answers. For example, it just doesn't work to come into a stranger's presence and immediately ask about his bowel habits or sexual practices. Timing is everything. Only after the patient "softens" to the idea of your presence and your mission does an honest, accurate and complete interview become possible. You will not get good information if your timing is off, especially if a situation involves child or elder abuse, sexual assault or some other deep emotional hurt.
A good question is relevant. Questions must appropriately "usher" the unfolding of the patient's story. Getting ahead of (or lagging behind) the place in the story where the patient is emotionally can interfere with a successful interaction. Many curiosities arise during the course of meeting and interviewing other people--things that you wonder about and would love to know. But if you get off the tract, it can be hard to come back. Furthermore, the patient may feel you are being nosy and clam up. Or you may move so quickly down an informational pathway that relevant information is left behind.
A good question paves the way for subsequent investigation. In keeping with the issue of relevancy, the rescuer can ask questions that lead the patient on to the next question in a natural and comfortable progression. Avoid questions that cause the interview to stop in its tracks or allow the patient to close doors on relevant avenues of exploration. At the same time, be prepared to let the patient "lead" you down unexpected pathways. Remember, the purpose of asking questions is to find out the truth. If you prejudge the situation and make too many assumptions, you'll get the story you believe every time--regardless of whether it's correct.
Good questioning skills are difficult to achieve. Learn from every opportunity. Listen to others as they interview patients and bystanders. Consider what you might say differently. Review every exchange in order to learn and improve. And strive to become as self-aware as possible so that you can "see" which of your own behaviors enhance or interfere with your interactions. As writer William James once said: "Whenever two people meet, there are actually six people present: each as he sees himself, each as the other sees him, and each as he really is" The more you see yourself as you really are the more you can honestly understand how others perceive you, the less confusing your interpersonal relations will be.
Kate Dernocoeur, EMT-P, is a regular contributor to ON SCENE and the author of Streetsense.
Reprinted with permission of Rescue, copyright 1991: JEMS Communications, P.O. Box 2789, Carlsbad, CA 92018.