The One Question Your Doctor Should Ask

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I knocked on the door of the hospital room. A tentative voice called from the bathroom, “Just a minute.” I entered, looking impatiently at my phone and thinking of the mound of paperwork waiting for me back on my desk.

A tiny, elderly man with wiry grey hair appeared from the bathroom. “I’m sorry. I’ve just been sick, and I’m afraid I’ve messed up the whole room,” he said as he shuffled slowly toward the bed.

I put my phone away and peeked around the corner. He was right. The bathroom was a mess.

I helped him into bed, pulled his blankets up, and pressed the nurse call button. I talked with him about palliative radiation treatments, and he agreed to come down for a planning session the next day. As I was leaving, a nursing assistant entered the room. “What’s up, doc?” she called to him as she wiped the anti-bacterial gel on her hands. As I dug into his chart later, I found that he was a renowned classical musician and professor.

I replayed the interaction as I drove home that evening, chastising myself for not spending more time with him. I thought about his vulnerability and my task-based approach. I needed to know if he wanted to continue cancer treatment, and I approached him that way—a woman on a mission. He was cooperative, kind, and decisive. He rapidly shifted from the embarrassment of the bathroom situation to a high-level goals-of-care discussion with me. As I contemplated how I could have handled that situation differently, I wondered what his experience was. I had gotten the information I needed, but had I truly cared for the patient?

Dr. Harvey Chochinov introduced the Patient Dignity Question (PDQ) to try to quantify what dignity in healthcare looks like. Dozens of published studies have now validated this question: “What do I need to know about you as a person to give you the best care possible?” Wow. What a question! Just reading it, don’t you feel more engaged? Multiple studies have demonstrated an improved doctor-patient communication when this question is asked in a clinic visit.

A recent study looked at over 1,800 cancer patients in a palliative care clinic and found the most common responses to the PDQ revealed personal insights, like “I feel in control or at peace with my life.” Some patients revealed they had unfinished business that they wanted to resolve prior to death. The second most common group of responses related directly to their cancer diagnosis or treatment: pain, forgetfulness, or inability to perform normal daily tasks. And the final most common group of responses revealed how the patient viewed interactions with others: worrying about being a burden on others or what would happen to children/friends/partners when they are gone.

As I read this study, I thought back to the elderly man and the hospital room. He died a few months after our conversation. I wonder how he would have answered the PDQ. And I also wondered if he felt dignity in my care. Dr. Chochinov explains health care providers “are often the mirror by which patients and their families judge their own status within the system.”

People working in and around cancer patients are naturally drawn to caregiving. The challenge is translating that desire to care into the patient’s lived experience. As survivors, it can be helpful to think about how you would answer the PDQ and whether you have shared that with your doctor. What important piece of you is missing from your cancer care?