Four Questions That Help Drive Humanized Care Connections

January, 2016

Human experience improvement training is full of language that is meant to drive a closer connection between patients/family members and their care teams. There are the standard questions, such as, “What are your goals?” and, “How can I help?” There are even suggestions on wording, such as changing “Do you have any questions?” to the more inviting, “What questions do you have?” These questions are commonly taught and greatly help to improve communication in healthcare settings (and, frankly, many others). In the course of my experience, I’ve encountered three additional questions used by doctors in a care setting to help humanize their engagement with patients and families:

1. “What’s your passion?”

   At the 2013 Healthcare Experience Design (HxD) Conference in Boston, David Sobel, MD, MPH, Medical Director of Patient Education and Health Promotion at Kaiser Permanente, shared this question as his favorite to start encounters with patients in primary care. He explained that, as a physician, he hears patient complaints and discomfort all day. The “passion” question allows him to connect positively with his patients. If patients have no answer for the question, he knows to screen for depression. And when they have an answer, as they commonly do, he is able to tailor his health teaching accordingly. For example, if a patient with diabetes says his passion is fly fishing, Dr. Sobel can gear his teaching on blood sugar management to maintaining peripheral vascular to allow the patient to continue safely wading in cold river water. Connecting a treatment plan to a patient’s life interests is a much more powerful incentive than abstract instructions and health changes.

2. “Did I get it?”

   Marc R. Katz, MD, MPH, is a cardiac surgeon and Chief Medical Officer of the Bon Secours Heart and Vascular Institute in Virginia. Dr. Katz likes to take what he calls “the long view on health.” He was one of the first surgeons to adopt robotic heart surgery approaches after they were approved by the FDA. His reason? Despite a higher level of complexity (and therefore lower patient volume/throughput), recovery times for patients undergoing robotic surgery are significantly lower – meaning patients get back to their lives faster and with fewer complications after surgery. Like many surgeons, Dr. Katz walks patients through the ins and outs of surgery and helps them make informed decisions in their care. But Dr. Katz recognizes that patients aren’t the only ones who need to understand what’s important prior to surgery. At the end of the patient visit, Dr. Katz recaps his own understanding of the patient’s goals and preferences and asks, “Did I get it?” as a means of making sure he and his patients are on the same page.

3. “What are your greatest fears and concerns?”

   Physician leaders Edmund Landry, MD, Nelson Perez, MD, and Steven Pu, MD, at Twin Rivers Regional Medical Center in Missouri wanted to create a deeper connection between patients on their med-surg unit and the physicians and staff who worked there. Patients often arrive on the unit after journeying through the hospital’s emergency department or undergoing life-changing surgeries. To build connection, the physician leaders created the Sacred Moment on admission – a time for physicians, nurses, or other staff members to sit down with the patient right when they arrive on the med-surg floor and ask them about their immediate needs. A key question turned out to be, “What are your greatest fears and concerns?” It allows patients to express concerns about non-medical issues such as care for loved ones or changes that will be precipitated by their change in health status – concerns that often prevent them from focusing on medical instructions or plan of care. The question also allows care team members to connect with their patients as people, stepping away from their tasks and reconnecting to purpose.

4. “Do you mind if I get this all down while it’s fresh in my mind?”

   Every doctor knows that the Electronic Health Record (EHR) and computerized documentation can create a significant barrier between the patient and the clinician if it’s not used properly. Dan O’Connell, PhD, is a practicing clinical psychologist who also conducts training, coaching, and consultation in health care and professional service organizations, universities, and industry. Dr. O’Connell believes that technology can support the clinical visit, provided that clinicians introduce the computer as a valued asset in the patient’s care. Dr. O’Connell suggests using purposeful scripting that allows clinicians to say in two seconds or less why it is in the patient’s best interest to do a task while they are still here. For example, Dr. O’Connell suggests using the question “Do you mind if I get this down while it’s still fresh in my mind?” This creates a two-way partnership, engendering trust, increasing transparency, and allowing the patient to participate in creating his or her medical record.

What all three of these questions have in common is that they all help connect the patient and the provider on a human level – acknowledging and supporting human connections on both sides of the clinical encounter. They invite patients and providers to recognize and celebrate each other’s needs, emotions, and responsibilities. And they all take only a few moments to build a more humanized healthcare experience.

What are your favorite questions to create humanized care connections?