Asking “Who Are You?” Before “How Are You?” Can Bridge the Patient-Physician Canyon
Author:
Michael Gordon, MD, MSc
Citation:
Gordon M. Asking “Who are you?” before “How are you?” can bridge the patient-physician canyon. Consultant. 2018;58(5):e173.
How one recalls the influence of one’s parents depends on many factors. In most situations, they are an intrinsic and intimate force on how we develop as children into, presumably, fully functioning adults. Throughout human history, however, this has not always been the case. Ancient biblical, Greek, and more modern Western literature, both fiction and nonfiction, feature innumerable tales of parents who, for whatever reason, were distorted enough in their parenting approaches such that they inflicted anything from meanness to actual cruelty upon their children. In many cases, this custom was believed to be or promoted as the correct child-raising disciplinary approach, one based on a sense that sternness, punishment, and force were good for the soul and body, or at least necessary to mold a child into a hard-working, righteous, and disciplined adult.1,2
It is in many ways only in more recent (one could say “modern”) times that new attitudes developed, perhaps out of the studies of early pioneers in psychology that suggested that perhaps the opposite was the case—that tenderness, loving, and empathy were far more likely to help shape the kind of adults one wanted in the world. The old biblical dictum, “Spare the rod and spoil the child” (Proverbs 13:24), began to lose its sway, and what had been perceived as the parental right or even duty to use physical force has become cause for negative legal and social reaction or even punishment.
The role of one’s parents varies a great deal in our upbringing and the development of the values that sustain us throughout a lifetime, or that set the stage for complete rejection or rebellion, perhaps during one’s adult or mature or experienced years. When the parental role works well, meaning that it has a positive and sustained influence, it is something to be treasured. In such cases, at many times in our adult years, we may recall an event related to a parent that reinforces the reason for why we continue to revere that person and appreciate the impact they had on our life and values.
One such experience that I have had many times is my association of a piece of music and my father’s love for music, despite his lack of any formal training in it and little exposure to it during his childhood or developmental years. My mother, on the other hand, studied piano, was a serious dancer, and came from a family in which her mother (the grandmother who helped raise me) was a singer. I started piano lessons at an early age under the tutelage of an old-fashioned Eastern European music teacher whose motto, embroidered on a framed cloth on his piano, was Thomas Edison’s quotation, “Genius is one percent inspiration and ninety-nine percent perspiration.” This became internalized as one of my many life values.
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One evening, my father came home with a surprise for all of us—a 45-rpm record changer (45 rpm had only recently come on the scene to replace the then-standard 78-rpm record format). He took out the changer and, with a soldering iron, he connected 2 wires from the record changer to our old pre-war console radio. He then took out 2 musical pieces, Sergei Rachmaninoff’s Piano Concerto No. 2 and Ferde Grofé’s Grand Canyon Suite. Why he chose these 2 pieces was not revealed to me—the first is considered one of the greatest classical piano concertos; the second might be characterized as “light classical,” but it is in many ways a personification of American classical music that reflects with musical beauty one of the great wonders of the American landscape.
Throughout my life, both pieces have evoked in me a special musical connection and a deep kinship with my father. He influenced me in many other ways, but for a person who had not been educated in music, his musical impact upon me was profound and sustained. When I actually visited the Grand Canyon with my family as a late teenager, I could not help but recall the musical association, and now the 2 experiences are forever entwined and are a warm indelible memory.
How this connects to my medical practice and the profession of medicine is a key component of this personal experience. I have a dictum that I teach to my trainees: When meeting a new patient, before you ask, “How are you?” ask “Who are you?” That means you want to know about them, their personal life, their heritage, their interests, their career, and so on. By asking this question, surely in most situations you will be able to make a personal connection, some more profound than others. Sometimes it is places in common; sometimes it is as simple as a special cuisine about which you have something personal to share: “I love Middle Eastern food. What is your favorite dish? Which is the best restaurant in the neighborhood?” Sometimes the connection is deeper and can include people you both know or knew.
Once this personal connection has been accomplished, medical care can take place with a sense of comfort based on common ground and familiarity. This may or may not become important beyond the enjoyment of it, if and when difficult medical decisions have to be made. Ultimately, the key to accepting a difficult recommendation from a physician has less to do with whether the patient feels that the doctor is “smart” or not but instead is based more on trust—“This is a doctor whom I trust to do the very best for me.”3 Setting the stage with personal narratives helps achieve that goal.
Over the years, I have had such conversations with patients about music, and I sometimes have related the stories above to make the point about musical discovery and connections, which I believe lives in all people for whom music matters. It can matter when decision-making about one’s health comes into play. As a physician, use all the methods and tools available to you to help get through to your patients and their families.
Michael Gordon, MD, MSc, is a geriatrician at Baycrest Health Science Centre and a professor of medicine in the Division of Geriatric Medicine at the University of Toronto in Ontario, Canada.
REFERENCES:
- Craft C. An evolving debate on corporal punishment: deciding appropriate disciplinary actions for children. The Spruce. https://www.thespruce.com/what-is-corporal-punishment-27016. Updated January 8, 2018. Accessed March 13, 2018.
- Anderson MD. Where teachers are still allowed to spank students: corporal punishment is legal in 19 states. The Atlantic. December 15, 2015. https://www.theatlantic.com/education/archive/2015/12/corporal-punishment/420420/. Accessed March 13, 2018.
- Blendon RJ, Benson JM, Hero JO. Public trust in physicians—U.S. medicine in international perspective. N Engl J Med. 2014;371(17):1570-1572.