1. Bolwell, Brian J. MD, FACP

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I remember my residency in internal medicine well. It was a time of no restrictions for house staff duty hours. I was in the ICUs, on call, every other night working until noon the following day. It was pretty exhausting. I remember going to see a movie on one of my nights off that I was looking forward to seeing. Unfortunately, I fell asleep 5 minutes into the movie and woke up as the credits rolled. When I told this to my co-residents, none were surprised, and most said I must have appreciated the sleep!


Social psychology tells us that one reason why some groups have difficult initiation rites of passage is that traversing a shared challenge generates significant camaraderie. That was certainly true for us. The crazy workload made our residency class close. While not all of us were friends, we were all colleagues and co-workers committed to our task with mutual appreciation and respect. There were a few exceptions- exceptional people that were truly liked by all, colleague and friend.


One example was a member of our class, a resident who later became a psychiatrist. I remember watching her in group social situations and admiring how people gravitated to her like a magnet. As I got to know her better, I discovered one of her many secrets-she asked questions. People opened up, seemingly connected to her on a different level. She broke down social barriers and created meaningful connections. Even when it was just the two of us talking at the end of the day, she asked me questions. I realized that asking questions was an excellent social technique to engage others, and I have used this concept to this day. It's a skill, taught and learned, and one that requires practice.


This skill is emphasized in May's issue of the Harvard Business Review. The lead article on leadership is "The Surprising Power of Questions" by Alison Wood Brooks and Leslie K. John. It starts by saying that most of us don't ask enough questions, nor do we pose our questions in an optimal way. The introduction goes further stating, "the good news is that by asking questions, we naturally improve our emotional intelligence, which in turn makes us better questioners-a virtuous cycle."


Let's pause there. Those of you who have read some of my previous articles are aware how much I value emotional intelligence (EQ). I try very hard to recruit people with EQ, and try to cultivate it in our cancer center (Oncology Times 2017;39(13):16). The challenge is how does one grow EQ? Many believe that it's exceptionally difficult, that behavior is fixed. I do not believe this to be true, but I do acknowledge that developing and growing EQ takes significant effort. I never thought that asking questions could develop EQ-but of course it makes sense. A big part of EQ is seeing things from the perspective of others, yet you can't know the perspective of others unless you ask! Once I read the introduction, I proceeded through the rest of the article with vigor.


The authors cited studies that correlate asking questions to liking people and stated that asking questions unlocks learning and improves interpersonal bonding. Importantly, they state there are four types of questions, and not all are created equal.


1. Introductory questions ("How are you?)


2. Mirror questions ("I'm fine, how are you?")


3. Full switch questions (those that change the topic of conversation entirely)


4. Follow-up questions (ones that solicit more information)



Follow-up questions have "special power." Specifically, follow-up questions "signal to your conversation partner that you are listening, care, and want to know more. People interacting with a partner who asks lots of follow-up questions tend to feel respected and heard."


Leadership development and character development are one and the same. A leader should respect all members of an organization, at every level. For that matter, we all should respect everyone who works in our cancer centers, no matter how large or small a job they have. One way to achieve this is to ask questions. And, importantly, if you ask "how is your day going?" follow it up with a question that demonstrates you were listening and engaged. Doing so demonstrates that you respect what they had to say. And, it will undoubtedly make them feel good. It's a great way to engage others, and to engage your workforce. At the end of the day, people want and need to be heard.


I think it is essential for leaders to ask questions. More importantly, leaders need to be comfortable and have enough personal security to be able to hear diverse opinions and put their ego aside. It is easy for leaders to squash open dialogue with their authority. Some make it clear that all they want to hear is opinions that are similar to their own. Other, more progressive leaders, will invite dissent, and make sure that all are included in the conversation. One way that I try to achieve a culture of openness is to say "I don't know" a lot (Oncology Times 2018;40(1):19-20). For all my years of education and experience, there is always more to learn. It is disarming to many when I say "I don't know," and it tends to relax the room. I also may state my opinion, but welcome anyone to educate me if I might be wrong. I like to go around the room and call on people, especially if it's a meeting with many in attendance. Questions are essential to all of this-having an open and transparent organization, having a culture of honesty and one that welcomes diverse perspectives, and engagement of your team. I want to know what's going on, why, and what we can do to make things better. To do that, opinions need to be challenged. Questions must be asked.


Finally, asking questions is good for you. You learn new things. You grow. Answers may surprise you. An awful lot of people have a story to tell that is interesting and informative and may intersect with your career, your passions, or your life. You have to listen. How patients answer your questions can inform a course of treatment and their care. Patients want to talk to you, they want to tell you the issue of the day. Let them talk. Let them tell you. Give them the time, the space, and the attention they deserve to tell their story. Really good doctors know how to ask good questions and hear the answers.


Sometimes my suggestions are not easy to implement, let alone to try. But hey, we can all ask more questions. You may be pleasantly surprised how engaging and useful it is, and you might even learn something new. It's even possible that asking questions will grow your EQ-something we all should continue to try and develop. Most importantly, you will likely be a better person if you ask questions. Brooks and John say in their closing paragraph that "the wellspring of all questions is wonder and curiosity and a capacity for delight." Give it a try.


BRIAN J. BOLWELL, MD, FACP, is Chairman of the Taussig Cancer Institute and Professor of Medicine at the Cleveland Clinic Lerner School of Medicine. Cleveland Clinic is a top 10 cancer hospital according to U.S. News & World Report.


Straight Talk: Today's Cancer Centers

Brian J. Bolwell, MD... - Click to enlarge in new windowBrian J. Bolwell, MD, FACP. Brian J. Bolwell, MD, FACP