PREVIOUS: The Smorgasbord Question

When a clinician sees hints of a story (see The person speaks as a whole), and jumps on these prematurely, the patient may be alienated. For example, the clinician asks The Smorgasbord Question, enquiring about the times around when the headaches began 15 months ago. The patient responds: ‘Oh, it was about the time my husband retired’. I might then ask ‘what was that time like for you?’ She might say something about ‘an adjustment’, and I might enquire and uncover the feelings behind that adjustment.

Too many clinicians are in a hurry, or get prematurely eager or excited about finding stories, and rush the patient, in effect offering the patient the clinician’s story.

But the important thing is not to jump at these hints like a dog at a bone. Check that it is a bone! It is crucial not to ASSUME that YOUR experience or knowledge of life MUST be what is happening for this person. In this case of headaches, knowing now that they started around the time of adjustment when her husband retired, I would also ask what was happening around 4 months ago when the headaches got worse. She might reveal that her daughter decided to go back to work and expected her to look after her baby 3 days a week. Again with interest and empathy I might uncover her feelings about this, and they may well be similar to or related to the feelings she had when her husband retired. The real story BUILDS as we talk together.

Too many clinicians are in a hurry, or get prematurely eager or excited about finding stories, and rush the patient, in effect offering the patient the clinician’s story. This is likely to irritate. The patient may feel colonised, even if the clinician is accurate. This is particularly a risk with clinicians who are still in the need-to-be expert mode, and are used to operating top-down rather than bottom-up. Diagnosis is more top-down (clinician-centred); getting the ‘story’ is more bottom-up (person-centred).

Brian Broom

NEXT: The emergence of meaning