The Smorgasbord Question

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One of the most useful tools to open up a story is the smorgasbord question. For example, in the course of thorough conventional clinical enquiry you have discovered that your patient has had severe headaches (or any other symptom) for 15 months and that they got worse about 4 months ago. You are of course alert to sinister possibilities like brain tumour or temporal arteritis and other diagnoses, but don’t think those are likely. You then ask: ‘What was the most interesting, memorable, significant, troublesome, difficult, problematic, hard, worrying, frustrating, stressful thing or things happening in your life around about the time the headaches came on?’ Basically you are offering an open choice for the person to bring up whatever they feel is right for them.

What was the most interesting, memorable, significant, troublesome, difficult, problematic, hard, worrying, frustrating, stressful thing or things happening in your life around about the time the headaches came on?’

Some people will immediately say ‘nothing’! There never is nothing going on in a life; but the person may be instantly ruling out thinking about it, or habitually accustomed to being ultra-positive (despite circumstances), or frightened to hear themselves verbalise something difficult, or as yet not tuned into the possibility that there may be connections, or instantly believing that you are looking for something major like a death, a marriage breakup, or a job loss etc. I help them by gently encouraging them to just take a moment, think back, perhaps wonder with a family member (if present), and remember what was going on at that time. With gentle encouragement many will start to tell me what floats to the surface.

The question then is how important is this material? Generally-speaking, that which IS important floats up in some form (see The Person speaks as a whole). But we must not jump to conclusions!

Brian Broom

NEXT: Don’t jump to conclusions!

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