Why do you ask?

It is all too easy to forget that it is (or should be) entirely about the patient.

During his recent physical my patient mentioned a skin lesion, noted by his wife, on his lower abdomen. He did not think it was new, but his wife had told him to be sure to ask about it. During the exam I examined the lesion, identifying it as a benign seborrheic keratosis.  After the exam was done and he was dressed, I launched into my oft-repeated discussion of seborrheic keratoses, their natural history, the reasons no biopsy or excision were medically necessary, and the various therapeutic options. He patiently let me blither on until I was done (he was more polite and more perceptive than I that day) and then said: "That's fine. But my wife just wanted to be sure she won't catch it." 

I had not asked, ‘Did she say what bothers her about it?'  Instead, I had focused on my needs: to identify the lesion, teach him about seborrheic keratoses, and explain what I could or could not do about it. Because I did not know what the question was, I had managed to expend considerable energy but not answer it.

Note to self: it is the patent’s health and health care, the patient’s visit, and the patent’s agenda.



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