The Art of the Question

Many physicians teach medical students in their office practices.  They share teaching pearls in exam rooms or between patients. They show students important interviewing and examination techniques; they model professionalism.  It’s not easy for physician teachers to do these things today, particularly given the pressures on clinicians to see more patients in shorter periods of time- not to mention keeping up with documentation requirements and administrative tasks. 

One, efficient way to teach is by asking a good question.

What characterizes a good question?  A good question stimulates learning. The question itself is important, but so is the wisdom and skill of the teacher: is she aware of the student’s level of training?  Does she ask questions in an empathic, encouraging way?  Does she ask them at the right time and right place? Is she judicious in her use of questions, not overwhelming the student with question after question? 

It is not necessary to teach on every patient.

Consider the following questions to ask students and residents in the office:

• What do you think is going on with this patient today?
• What evidence supports your conclusion?  
• What else could it be?
• What if the patient presented in the following way… how would that change your assessment?
• What are the 2 most important things you learned today?
• If I weren’t here to help you, what would you do with this patient?
• If you saw this patient again, what would you do differently?
• What patient inspired you today? Why?
• What made this patient visit particularly difficult for you?
• After today’s session, what questions are you going to research- and teach me about- tomorrow?

I hope physician teachers will reflect on these questions- and add a few more to the list!

–Dean Gianakos, MD, FACP

Dean Gianakos, MD, FACP, practices and teaches general internal medicine in the Lynchburg Family Medicine Residency and Geriatrics Fellowship, Lynchburg, VA.  He frequently writes and lectures on the patient-physician relationship, end-of-life care, and the medical humanities.