An important assertion about questions!

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questionWe use questions for all sorts of things.  To assess and create plans of care, to find out information about topics or other people of interest, to understand another’s point of view, or to interrogate suspects.

Sometimes intention plays a role in the types or manner in which we ask a question.  “Is that your green car over there?”, could be an effort to help you avoid a parking ticket, find out if you’re the one who ran over my bike, learn more about your color preferences in automobiles, or see if you’d be willing to give me a ride!  And of course, intention can be influenced by our relationship, e.g. friends, strangers, colleagues, etc.

Okay, so those are some of the more common characteristics about questions, but here’s a thought you might not have considered.

Do we use questions to avoid assertiveness?question

Actually I just did it!

I could have said:

We use questions to avoid assertiveness!

See the difference?  The statement is confident and I present myself as an expert!   I’m writing this blogpost and teach communication so it makes sense that I would have an opinion, and an educated one at that!  Why don’t I just state my point?  (Oops, another question!). I should just state my point. Even better, I’ll state my point!

Nurses will especially relate to the idea that we are giving our power away when we ask questions of physicians that we know or suspect the answer to.

For instance:

Did you want to order a CXR?  

Notice how this is emotionally safer and deferential, but I give up my power.  The CXR and my input may or may not be ordered.  Business as usual! 🙂

I think a CXR would be a good idea! 

120px-The_answer_logoIn the second example, the physician, nurse practitioner, or physician’s assistant can agree and thank me for the suggestion and the CXR decision is shared.  If she does not agree, she’ll have an opportunity to role model and teach collaborative leadership by thanking me for my input and explaining  why a CXR wouldn’t be a good idea in this situation.  My value is noted in either case, our professional relationship deepens, and the patient gets a helpful test or doesn’t get an unnecessary one!

Here’s another example:

Did you know that patient is allergic to penicillin?

or

That patient is allergic to penicillin!

Asserting what we know or what we think is a great way to build awareness of the value we bring to the table.  I continue to learn about this by taking and teaching improv.  In fact, not long ago I discussed this very concept in a podcast for NAIMP.org and if you listen closely you’ll hear me actually ask a question and correct myself.  Avoiding questions is one of the principles of medical improv and this is exactly why it is so valuable!  Oh and if you are a leader, you can help others develop their assertiveness by suggesting they reframe questions into statements! Oh the complexity of communication, it goes on and on!

This entry was posted in Communication in Healthcare, Complexity in nursing, Diversity, Healthy Workplaces, Holistic Health, Medical Improv, Nurse Leadership and tagged , , , , , . Bookmark the permalink.

5 Responses to An important assertion about questions!

  1. Pingback: Physicians, PAs, & APRNs! Weigh in on 3 questions!

  2. Very interesting topic, Beth! And interesting discussion as well. I think of statements posed as questions in a little different light. As someone who is pretty straight forward with my opinions, I have found that my statements can turn the other person off to the info I’m imparting by way of my declarative statement or maybe its my manner. If I state an opinion, I tend to believe in it.
    I try questions (to deliver the same message) as a way to help the other person hear the info instead of the way I deliver the message. To me, the message, such as the patient is allergic to penicillin, is much more important, than how I feel delivering it. I don’t feel disempowered, by the way, by doing this.
    When I sense the person I’m talking to might be threatened by my delivery, or by the strength by which I’m imparting info, I sometimes soften my delivery by using question form.

    I do, however, see your point about people, especially women, using questions instead of declarative statements. Our voices tend to go up at the end of sentences, making it sound like we are asking for others’ opinions about what we have just said. That is most ineffective (and I’ve done it myself unfortunately) when desiring respect from others. So… I think I’ve contradicted myself in some ways here. What do you think? Ha Ha.

    • Beth_Boynton_RN_MS says:

      I think these are great points, Martine and offer yet another perspective. Your awareness of being direct and how that impacts others….or at least some others seems like an important insight in terms of ensuring that your message is received. I hear that you don’t feel disempowered by asking questions that you know the answer to and it helps to shed even more light on how differences impact communication.

      I grew up with 4 brothers and am 60 so grew up during the feminist movement. I was a more direct communicator before I got into nursing. A complex time for sure and with most nurses being women there is a lot else potentially going on here. Nevertheless, I believe some messages I got as a new nurse were to be quiet and maintain low status.

      With regard to the message being delivered being more important than feelings around sending or receiving, I can see your point in any single situation. Making sure the patient doesn’t get the med he is allergic to is imperative.

      On the other hand, a pattern or patterns of such behavior contribute to a false sense of knowing on one side and a false sense of not-knowing on the other. From a patient safety standpoint both of these are very dangerous. Also, since they are both false messages they chip away or can chip away at our true sense of self.

      So perhaps questions like these can be a tool to be used with a little caution? If you’re working on developing assertiveness, it might be good practice not to use them, while as you suggest, if you are looking to soften your approach in dialogues they can be helpful.

      At any rate, the conversation seems important and I appreciate you sharing your awareness and strategy.

  3. Buck Rogers says:

    Here’s a suggestion from a Doctor who was also a nurse – ” I think a chest x-ray will be a good idea” will not usually be met with the response you are predicting – “I’m not interested in what you think” will be the typical response from most physicians. “Did you see his chest x-ray?” or “What did his chest x-ray show? will get the doctor thinking about ordering one. “The patient is allergic to penicillin” is essentially an alert and will always be appreciated as will alerts about lab values, x-ray findings, ecg findings, etc. An alert and/or reminder promotes patient safety and quality without challenging the physician’s expertise.

    • Beth_Boynton_RN_MS says:

      Hi Buck, thank you for your interesting insights. They reveal another dimension of the problem, i.e that physicians don’t care about what others think. Nurses or patients. I’m sticking with my recommendation because, if nothing else, it will help to surface underlying problems like this. The questions you suggest will help lead the physician but hide the nurses’ knowledge and experience. In fact, they perpetuate the myth that what nurses (or patients) have to say is not worth listening to. It is an old old game that potentially hurts everyone. True collaborative leaders should invite challenging of their expertise. It is good for patient safety, teamwork, and overall quality improvement. Whereas not doing so is oppressive and dangerous! This means docs and other leaders have to learn how to share power while nurses and others have to become more accountable and take on more power. Scary for all b/c our egos are in the mix. We need to change this game and I am grateful for your very relevant points!

What are your thoughts?