The eight questions

[Wagner, Teresa M.]

interesting

-T.

> ----------
> From: 	Margo Harris
> Reply To: 	pnwhealth at u.washington.edu
> Sent: 	Wednesday, December 22, 1999 2:13 PM
> To: 	Pacific Northwest Health Educators
> Subject: 	The eight questions
> 
> I've gotten several posts from folks also reading The Spirit Catches You
> and
> You Fall Down.  If you haven't gotten there yet, the eight questions are
> on
> pages 260-61.
> 
> If you're not reading the book but want to know the eight questions, here
> they are:
> 1.  What do you call the problem?
> 2.  What do you think has caused the problem?
> 3.  Why do you think it started when it did?
> 4.  What do you think the sickness does?  How does it work?
> 5.  How severe is the sickness?  Will it have a short or long course?
> 6.  What kind of treatment do you think the patient should receive?  What
> are the most important results you hope she receives from this treatment?
> 7.  What are the chief problems the sickness has caused?
> 8.  What do you fear most about the sickness?
> 
> While it is an open-ended strategy, this is somewhat related to eliciting
> patients' salient beliefs about a health condition.  Kate Lorig and others
> use that technique, and Kate writes about it in her book, Patient
> Education,
> (both editions).  She notes that, "from psychology, we learn that human
> beings can have only seven or so beliefs or opinions about any one
> subject.
> These have been called 'salient beliefs' (Miller, 1956, Fishbein & Ajzen,
> 1975).  If you can identify these beliefs, you can then use this knowledge
> as a basis for your educational efforts.  Assessing salient beliefs is
> especially good for the busy health care provider to use in one on one
> situations.  A very simple way of soliciting these beliefs is to ask the
> client, 'When you think of _____, what do you think about?'  The blank can
> be filled in with any behavior or disease (e.g., exercise, cancer).  The
> answers that you get will give you good insight into that person's beliefs
> and concerns about that particular condition or behavior."  I have used
> that
> technique for years.  Like Kleinman's 8 questions, it seems deceptively
> simple, but the answers are rich with information.
> 
> In fact, Fadiman says something similar about Kleinman's questions, "The
> first few times I read these questions they seemed so obvious I hardly
> noticed them; around the fiftieth time, I began to think that, like many
> obvious things, they might actually be a work of genius."  That's one of
> the
> messages in my presentation, that using some simple tools and gathering
> more
> valuable information that reflects the patients' (or family's) perception,
> may truly help a provider more than he/she suspects, thereby narrowing the
> gap between patients and providers.
> 
> I have a physician friend at Duke in North Carolina, and she and I talk
> about this issue all the time.  Some time ago, she told me that she'd
> learned that in fact there were no truly difficult patients, rather
> providers who didn't take the time to understand and negotiate the
> situation.  Now I dislike the label, 'difficult,' but I'm also not ready
> to
> suggest there are no people who fit in this category.  Still, the idea of
> understanding and the need to negotiate are central to this
> patient/provider
> separation.
> 
> Keep the comments coming, and thanks for the replies.  Margo
> 
> Margo Harris
> Technology In Education Institute, Seattle, WA
> Email: margo at techined.com
> Web: http://www.techined.com/
> "If not for STRESS, I'd have no energy at all."
> 
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