Growing up, I am sure you heard many “why” questions, such as: “Why is your room so messy?” and “Why didn’t you eat your vegetables?”  I am quite certain those questions made you feel defensive.  Patients also feel defensive when we ask them ”why” questions. In other words, “why” questions set people off.  These types of questions can turn a usually-friendly patient into an angry nightmare.

Here is an example.  Your patient, who has been experiencing many stressful life events, just told you he stopped taking his medication.  Here are two possible responses:

• “Why” question:  “Why did you stop taking your medication?”

• Better question: “I care about you. I want to you to feel better. I know you have been going through a rough time. What was happening that led you to stop taking the medication?”

The “why” question may cause the patient to become defensive.  However, the better question will most likely put the patient at ease. The better question has many important elements:

Use of “I” statement.  Using this type of language shows the patient you care about them and their medical situation.  (“I care about you. I want to you to feel better.”)

Use of empathy.  Using these types of statements shows that you are concerned with the emotional needs of the patient.  (“I know you have been going through a rough time.”)

Convert “why” to “what.”  The above example illustrates that using a “what” question is much friendlier during patient discussions.  (“What was happening that led you to stop taking the medication?”) As an alternative, I have also said to patients who stopped taking their medications, “What can we do to get this medication back in your life?”

Combining “I” statements, empathy with a “what” question is a much more effective substitute to the dreaded “why” question! Notice the “I” statement and empathy came first; empathize before you educate! It is important to first show you care.

Case study #1

A man has been having GI distress for several days, but delayed coming to the emergency department. You need to know the reason he put off going to the hospital.

• “Why” question: “Why didn’t you come to the hospital sooner?”

• Better question: “I am concerned about you. I want you to feel better. What was reason you did not come to the hospital when your belly first started to bother you?”

Case study #2

You are seeing an elderly woman in your office. The woman has a history of edema in the ankles and wears support stockings.  During your examination, you notice her ankles are edematous. She stated she has stopped wearing the stockings.

• “Why” question: “Why did you stop wearing the stockings?”

• Better question:  “I want you to be well.  I am here to help you. I see your ankles look swollen. The stockings help prevent that from happening.  What is the reason you stopped wearing the stockings?”

Through avoiding the use of “why” questions you will dramatically strengthen relationships with your patients. In addition, avoid asking “why” questions when talking to co-workers, family members and friends! Nearly everyone becomes defensive when faced with a “why” question.

Edward Leigh is founder and director, Center for Healthcare Communication.