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Beware asking leading questions

I had a pacemaker fitted about four years ago.

The nurse that checked me into a private hospital for the procedure told me my name; "Hello, it's Mr Trevor Dale, isn't it?".

She proceeded to tell me my date of birth too, and what I was scheduled to have done that day.

After confirming "yes" to all of her questions, I asked her to start again and ask me my name instead of telling me my name, as she was supposed to. She responded with "yes I know I'm supposed to but …" Clearly, she didn't understand how dangerous that can be. How many times has the wrong answer been given because often patients don't like to cause upset' or they're merely stressed or ill and didn't hear correctly, or just didn't want to argue? The doctor knows best?

Many of you have had this particular issue where you've ended up with the wrong patient or made incorrect assumptions.

There's a funny story of a gynaecologist running a clinic in a part health care, part social care environment. She entered the waiting room and said, "Mrs Patel," and this woman said, "Yes." And she said, "Please would you come in and would you get undressed? I'm going to examine you."

The gynaecologist gave her patient a hysteroscopy and said, "Everything's fine. You'll be pleased to know no problem at all." And the lady said, "But I came here for housing benefit?"

And of course, it's the wrong, Mrs Patel. By the way three days later, a lawyers' letter arrived – invasive procedure without consent!

Over the years, I've met a lot of people in health care and social care who have experienced the same issue.

A consultant doctor recently told me he ended up telling a patient he had terminal liver cancer. It was only when he said to him, "Would you like to look at your scans with me?" that the patient told him he hadn't had any scans, and the doctor realised he had delivered such bad news to the wrong person.

Healthcare professionals are often embarrassed to ask their patients, "Could you tell me your name?".

I observed an ODP, a few years back, saying to a patient, "It is Mrs Jones, isn't it? Your date of birth is blah. And you're here to have your left knee operated on aren't you?"

Which is fine, but his colleague I went with separately said, "Now I know you're going to hear this 20 times today, Mrs Smith, but this is just for your safety, could you please tell me your name and your date of birth and what you think you're here for?" Which of these approaches do you believe is safer?

I observed another interesting one, only last week, where there was a chap who was very ill, with sepsis amongst other things and a kidney stone and multiple comorbidities. He was under heavy sedation at the time, and the ODP asked him, "Why are you here?" Of course, he didn't know and said as much in reply.

One of the ODPs asked the question in a much more effective way; "Do you know what's wrong with you?", to which the patient explained he had been told he had a kidney stone.

There's another case we know recently where a junior doctor went and consented a patient, said, "It's your right leg, isn't it?" Yes, here's an arrow on your leg. They got the consultant to countersign the consent.

The patient had dementia and didn't know if it was Christmas or Easter, let alone which leg it was. And of course, as luck would have it, it was the wrong leg.

Asking leading questions is part of human nature. It's a quick and easy approach, rather than what we prefer to see during a team briefing or safety huddle, which is "Does anyone have any concerns?"

So instead the lead says, "You're happy, aren't you?" It's closing the conversation down. People got to put a real effort in to ask a question or say they're not happy.

Whereas if you say to someone, "Do you have any concerns?", it opens up the conversation to the rest of the team.

Bearing in mind that some people are more reticent, and need to think things over and weigh up whether they're essential or not in their minds, then it's allowing them to speak up, especially if there's any level of hierarchy involved.

This issue of leading questions ties in with different nationalities and cultures experiencing different attitudes to people in authority, something identified by Hofstede's work on power-distance and nationality.

There was a Swedish lady on a course only last week, and she found all this stuff about deference to people in authority to be quite funny. And I said to her, "Do you know that the Swedes have the lowest inbuilt attitude to hierarchy of all the nationalities in the world?"

Her attitude in an open class discussion was precisely that as a Swede, and the Swedes do have a very flat hierarchy. And if anything, I think it can produce the reverse result, where they have difficulty showing appropriate respect to people in authority.

The consequences of asking leading questions can be pretty alarming, so please don't do it! Always ask open questions.
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