Why: The most important letter of healing alphabet

(Originally published by Hospital Impact)

I was blessed to have dinner with a skillful, heart-centered physician the other night. At one point in our conversation he looked up at me and confessed, “I assume way too much.”

Of course I could not let this seemingly disjointed comment lapse and pressed for more information.

“We doctors, we are great with the ‘what’ and the ‘how’ of healthcare. But we are terrible with the ‘why.'” He then connected the missing “why” to his habit of making assumptions.

“I can tell patients all day long that they must eat right (the what) and even how to do so, but too often I don’t tell them the why. And if I do, most times I don’t share the specific why that will truly touch them. The why that will actually engage my patient and lead to a change in behavior,” he said. “Too often I assume I know all I need to know about my patient when I truly don’t have a clue.”

This caring healer then went on to recall a recent patient visit that touched him deeply and led him to his conclusion.

A new patient came to his office. This man, in his mid-50s, was dressed shabbily, unshaven, uneducated and newly diagnosed with diabetes. My friend said he assumed he knew all he needed to know about this individual based on the patient’s appearance and based on the information documented in the medical record. And with 30+ patients to see this day it was time to get in, check off all the appropriate boxes, share his knowledge and move on to the next patient.

“And then while I was working my way through the patient’s checkup the patient looked up at me and said, ‘Hey Doc, you are ambidextrous.'”

Those five words “Hey Doc, you are ambidextrous” made him stop in his tracks. Suddenly he realized this patient was both articulate and, in fact, educated. As he continued to process those five words, he also processed the encounter, what he saw, what he read in the chart, all the assumptions he had made and said to himself, “No, this is not right. I actually know very little about this patient and very little about how to best help this man.”

He then acknowledged that yes he was triple booked the rest of the day and was not scheduled to spend more than a few minutes with this patient, but he was going to take as much time as it required to connect with this patient, get to know this patient and communicate with this patient to the best of his ability (and become a physician healer again … not a factory worker). He was no longer going to assume but rather ask, listen, be open and learn.

So my friend sat down with this man and learned that this patient was a long-distance truck driver but due to his recent diabetes diagnosis could no longer drive the long distances and was very unhappy about this change.

My friend asked his patient if he knew what insulin was and what it did. He asked him about his Hemoglobin A1C levels and whether he knew what the numbers meant. And he took the time to explain. He asked his patient to imagine insulin as the vehicle (a truck) that delivers glucose from the bloodstream into cells that need energy … and he made a real connection with his patient.

Over the course of an hour and with much sharing and learning, this patient began to understand his disease. And with further discussion he better understood the “what” and the “how” of his illness but also the “why.” Why it is important to monitor blood sugar levels. Why he feels the way he does. Why insulin is important. Why long-distance trucking is a challenge. Why eating a certain way is beneficial. Why exercise is important. Why. Why. Why.

As tears welled up in my eyes on hearing of this wonderful connection, not only to his patient but also to himself and his true calling, we discussed the reason for his many assumptions, as well as the barriers to reaching the why.

In addition to owning his culpability, my friend also pointed to the limited time available to clinicians with their patients to truly connect, to establish relationship and trust, or to truly hear the patient’s whole story (rather than assuming).

“As healthcare leaders we have an obligation to ensure we create optimal healing models. And these models must include the ‘why’ … the most important letter in the healing alphabet,” said my friend, who is part of a physician leadership group.

That experience taught him that not doing so can harm patients and practitioners by creating a lack of understanding, noncompliance and less-than-optimal outcomes. “It also leads to a disconnect between clinicians and themselves (their true passions and the real reason they became healers in the first place),” he said.


  1. The “why’s” are, indeed, important. How, though, to find the time to implement this essential component of healthcare delivery, when physicians are triple-booked? As a nurse returning to the field after a 14-year absence, sadly, it doesn’t seem like a lot has changed in this area since I left.

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