The things we fail to say – a few simple questions help to fill in the gaps

It’s been several months since I’ve blogged regularly.

Fortunately, I’ve learned to appreciate that we all have seasons in our lives and a limit to how much we can/should push ourselves.  I’m better at prioritizing and forgiving myself when I don’t accomplish everything.

The reason I didn’t have the time or energy to write was because of a mountain of activities that all hit at once.  One of these was a minor remodel of our house.  I’ve come to realize that’s an oxymoron.  The words “minor” Screen Shot 2015-10-15 at 10.28.51 PMand “remodel” don’t usually belong in the same sentence.  While the workmanship on our home is excellent and we’re happy to be living there, the process was peppered with many stressful incidents.  One of these occurred as we contemplated replacing a series of windows with dual-paned glass.  “What will this cost?” I asked.  “About $14,000,” was the answer.  Eventually, we decided that $14,000, although substantial, was worth the benefits we and the environment would derive.

What we weren’t told was that $14,000 was the cost of the glass only.  It didn’t include the significant labor charges we would incur, as the glass didn’t easily fit into the space available.

It reminded me of a recent incident with a patient.  “Will Medicare cover my treatment?” he inquired.  We assured him that it would.  Then he went to check out and was told he owed $51 for the compression stockings we had fit him with that day.  “I thought you said Medicare would cover everything!” he yelled, as he threw the box of stockings down on the desk.

How do we get all the information we need, when we frequently don’t even know the questions to ask?  How can we anticipate what our patients and others in our lives want to know when they don’t ask?

It’s clear that in most situations, I need to ask more questions.  Simple, general questions are often the best.  “What other costs are involved?”  “What else do you think I need to know about this?”  Asking either of these would likely have saved a lot of misunderstanding.

And in speaking with others, we can listen for their major concern.  Patients who inquire about insurance coverage aren’t really asking if their care will be “covered.” As we know, this can mean that the insurance company will pay only a small percentage and leave them with a large sum of money to pay.  They are really asking how much they will have to pay out of pocket.  Patients who ask, “Will it hurt?” usually realize there will be some discomfort.  What they are worried about is whether they’ll be able to tolerate it. Again, using simple and general questions will help us focus our communication on what is most important.  “What concerns do you have about this?”  is one of the best questions I know.

Given that our thoughts are processed in milliseconds, we each respond to situations almost immediately based on our experience and psychology.  We frequently assume that others share our thought processes and come to the same conclusions we do, even though we are constantly reminded this isn’t so.  Taking a moment to ask some simple questions can help to make our communication clearer – by reducing those things we fail to say.

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About Helane Fronek

Over the past 28 years I have had a fascinating and fulfilling career in medicine, initially practicing as a general internist and then as a procedural specialist, caring for patients with vein disorders. As Assistant Clinical Professor of Medicine at UC- San Diego School of Medicine, I’m thrilled to be teaching medical students crucial communication skills along with many other aspects involved in the practice of medicine.
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