Dedicated to my friend and colleague Pat Irving to whom I first told the story.

I’m 80 years old and I’ve been writing for over 60 years—first in systems engineering, later in advanced technology, and more recently in public health policy for the regulation of pain medicine. At this stage of my life, some of my writing is introspective, in an attempt to extract and share “lessons learned” with others. Thus, these five questions.

When I graduated with my bachelor’s degree in electrical engineering in 1967, there was a war on. It was clear that if I didn’t volunteer, I could become a “grunt” hauling a rifle around the rice paddies of Vietnam. Some of my classmates didn’t come home from that war.

The Air Force was happy to enroll me in officers training school. To my surprise, 40 soon-to-be second lieutenants in my class were offered full fellowships to return to school for graduate degrees. The Air Force wanted to keep us, and we signed on for a two-year service commitment for each year in school. I would then become a staff officer in military acquisition management and national military intelligence. I would also be sent back for a PhD at UCLA under the same arrangements.

The arrangement seemed fair at the time and it wasn’t unusual. In the 1960s and since, technical schools of the Armed Forces trained more technicians and sent more officers and senior enlisted people through graduate school than the top ten U.S. universities combined. It isn’t going too far to say that a lot of civilian technology and progress was created by these people.

Contrary to impressions that many Americans have these days of service life, military leadership has never been primarily about ordering people around or swarming across beaches under fire, John Wayne style. Through 21 years and multiple exposures in professional military education, it was drilled into me that the first duty of military leaders is to teach mental discipline and focus, to empower our people and help them develop life competencies. The military mission does matter and can sometimes involve very hazardous conditions. But “take care of your people and they’ll take care of you” is a fundamental value in the mission.

Inevitably, not every junior enlisted person is happy to find themselves on a military base and rising in the mornings to the sound of reveille. Though young people are no longer drafted into service, some will bring along emotional or educational baggage, leading to adjustment problems. U.S. services spend considerable money training young people. So military leaders are expected—and trained—to work at preserving such investments and counseling their people to perform well in the circumstances where they find themselves.

We do not always succeed, but we try—and probably with far more consistency than in civilian life.

During my military career, training in employee counseling was focused on a series of five questions administered during a one-hour interview, sometimes with participation by an intermediate NCO supervisor who was more familiar with the interviewee and their adjustment issues.

“What brings you into my office?” There is often an overtone of being “called on the carpet” in such sessions. The interviewee’s participation is not always voluntary. Likewise, the interviewee may not have a clear mental picture of what “their problem” actually is or even that it is “their” problem. The objective of the first question is to clarify and de-personalize the problem in order to remove emotional resistance to imagining needed changes.

“What have you been doing about this?” Again, the objective is to engage the interviewee in self-examination of their behavior and the responses of others. If someone won’t recognize that a problem exists, then they won’t participate in solving it.

Participation is empowering for individuals. Unconsidered or reflexive resistance isn’t.

“How has that been working out for you?” Although the question might seem borrowed from the ministrations of Dr. Phil, it is highly pertinent. The central principle is that if something we are doing isn’t working, then something has to change—and we have to be the ones to change it.

“So what are you going to change?” The assumption is that the interviewee has the power to change and therefore an obligation to define what changes they will embrace. Nobody “does it for us” if we’re to get something lasting and positive from the process. We do change for ourselves and own it. This is no less true of employment counseling than of deeper psychological therapy.

“How will I know your results?” Especially in the early stages of change, “the road to hell is paved with good intentions.” In isolation from actual outcomes, intentions are not enough. Change often involves extended learning, with periodic progress evaluation or additional objectives. To evaluate progress, one needs defined milestones. Who is going to do what? When will it happen? How will we know it has been successful?

It might be complained that this process is untimely or even coercive. Likewise, the military may seem like a unique environment where there is much more power to compel behavior. However, I observe that neither of these ideas is true. The results of bad behavior while on active duty in the military may be more “official” and longer lasting than in a civilian workplace. But the employee can still get fired. That’s always consequential.

Likewise, an old and well-proven principle is no less true in civilian employment than in the military: “Ninety percent of your discretionary time will be spent on ten percent of your people.”

If you think you can’t spend that time or don’t know how to do so productively, then you will eventually limit your own promotion potential. You’re not a trained therapist, and some employee issues may need therapeutic support. But your job as a supervisor is to recognize what you can do, do what you can, and help your people find other resources when they need them.

The same principles may usefully apply when we change “you” to “me” or “I” in the five questions.

Richard A. Lawhern is a nationally recognized health care educator and patient advocate who has spent nearly three decades researching pain management and addiction policy. His extensive body of work, including over 300 published papers and interviews, reflects a deep critique of U.S. health care agencies and their approaches to chronic pain treatment. Now retired from formal academic and hospital affiliations, Richard continues to engage with professional and public audiences through platforms such as LinkedIn, Facebook, and his contributions to KevinMD. His advocacy extends to online communities like Protect People in Pain, where he works to elevate the voices of patients navigating restrictive opioid policies. Among his many publications is a guideline on opioid use for chronic non-cancer pain, reflecting his commitment to evidence-based reform in pain medicine.

Pat Irving is a nurse.