What Matters to You? vs. What's the Matter?

February 18, 2019 8:37 AM | Sally Winkelman (Administrator)

Jeffrey Pothof, MD, FACEP

Wisconsin emergency physicians, welcome to the February edition of the WACEP newsletter.  I hope all of you are as eager is I am to attend the WACEP Spring Symposium and 27th annual Emergency Medicine Research Forum.  We have secured a great venue in the Harley-Davidson museum and have some top-notch programming ready to go.  I hope to see all of you there April 3rd and 4th.  If you haven’t already registered, sign up today.

A handful of years ago I had an opportunity to hear Maureen Bisognano, then president of the Institute for Healthcare Improvement (IHI), deliver a keynote address at the Institute’s national forum in Orlando.  It was simple enough.  Instead of asking your patient “what’s the matter?”, we were challenged to ask our patients “what matters to you?”  This seemingly small change in words, can lead to a much deeper understanding of the patient and will improve the care you deliver.  I’ve used this approach in the ED and anecdotally can say it’s been effective in illuminating why a patients come to my ED, and allows me to better meet their needs.  Each patient brings to the ED a different set of life circumstances, they have their own fears and they have their own logic for seeking us out. 

By asking “what matters to you?” I discovered that the 35yo sitting in front of me worried sick about an episode of seemingly benign chest pain wasn’t the anxious hypochondriac I was suspecting, but instead was the child of a parent who passed away from sudden cardiac death at the same age.  What mattered to my patient was knowing that the same thing wasn’t happening to him.  The conversation we had around his fear was more impactful to him than the negative troponin or perfect ECG I was banking on.

By asking “what matters to you?” I witnessed one of my patients tear up and disclose the long history of intimate partner abuse she was suffering from.  I wouldn’t have figure that out by asking what was the matter with her abdominal pain.  Instead of ordering a CT scan, we conversed on how no one deserves to be treated that way, and I was able to share resources to try and make an inflection point in her life.

Many of you have similar stories where an encounter took an unexpected turn, and you experienced one of those moments where you connected more deeply with a patient.  A time when you made a difference not through anything you learned in medical school or residency, but because you took the time to listen and understand the human condition.

I challenge all of you on your next shift, or perhaps on all your shifts, to ask your patients not only what brought them in today, but what matters to them today.  I’d love to hear how this impacts your practice so if you are willing, share your stories with me