The following has been adapted from a commencement address I gave last month.
Congratulations, graduates! You’ve spent years preparing for this day, years of answering questions—on exams, in clinical debriefings, and in response to your patients’ inquiries. Knowing those answers has been essential to getting you to where you are today.
But now, as you launch a career of service to patients and society, you must become as adept at asking questions as you are at answering them. To be successful, you will need to embrace intentional questioning.
- Is asking purposeful, well thought-out, understandable, and well-timed inquiries
- Inspires the responder to take the next step into awareness, action, and insight
- Is not intended to stimulate recall or appraise comprehension, but to engage with another to engender wonder, reasoning, and action
Think back to the first questions you asked: Why is the sky blue? When is dinner? Where is Mom? These questions were motivated by a curiosity about the world, coupled with a need to feel tethered or secure. I want you to return to that childhood questioning—be curious, know your tethers.
Questions convey wonder about the world and about the “other.” Asking questions of our patients helps them reveal themselves and their concerns. Asking questions of science advances the knowledge needed to diagnose and treat the human response to disease, disability, and developmental challenges. Asking questions reveals where new technologies might help resolve complex health problems, and where innovative technologies may have inadvertently disenfranchised some of our sisters and brothers.
So, embrace asking questions, but ask your questions judiciously. Make sure the questions are worthy.
What does it take to ask good questions?
- A compelling need to know
- An understanding of the knowledge, skills, motivation, and cultural characteristics of the other
Forty years ago, when I attended my own MSN graduation at Penn, there was no iPhone, no internet, and no PubMed. Now I direct the largest biomedical library in the world, and every day five million people use our resources to answer questions. So, right now you could say I’m in the question-answering business.
But I got here by asking questions: How can computers help nursing? In what ways can we help people better take care of themselves? If we broadened the definition of health to encompass the social and behavioral domains, could we improve health overall?
These questions propelled my research forward and shaped my career. But I didn’t even know enough to ask them early on. No one did. No matter how skilled they were, my faculty—like your faculty—could not have anticipated the knowledge nurses would need in ten years, twenty years, fifty years. You must discover that knowledge, often on your own. That is exactly why you must become adept at intentional questioning.
Intentional questioning addresses three realms.
- Knowing self
- Am I ready?
- What more do I need to know?
- Who else should be with me?
- What would my future self wish I had asked of me now?
- Knowing the world (which can guide our research)
- What if … ?
- Who can help me know this better?
- What might be, or has been, the impact of innovation?
- Knowing others (such as patients)
- What brings you here?
- What can I do for you?
- What questions do you have? Because listening to the types of questions people ask and the way they ask them can teach us a lot about how they frame the world and add meaning to the important issues in their lives.
Questions are the starting point of dialogue and the starting point of engagement.
And once you ask a question, you must be ready to accept the answer. You don’t always have to like it—the answer to the first research question I posed turned out to be the exact opposite of what I wanted it to be, and then I had to do some fast thinking—but you must always deal with the answer.
Not asking questions
Finally, I must point out that sometimes not asking a question is more powerful than asking it.
Let me tell you a story about one of the most important questions never asked.
In Michael Frayn’s Tony Award-winning play “Copenhagen,” Niels Bohr, his wife Margrethe, and Werner Heisenberg reflect on a long-ago evening when Heisenberg visited Bohr to learn the secret of creating heavy water, which would have accelerated Germany’s development of the atomic bomb. Bohr, in a later conversation with his wife, confessed that he deliberately did not ask Heisenberg the one question that would have led Heisenberg along the line of reasoning that could have resulted in Germany successfully creating an atomic bomb.
Why am I telling you this story? To bring home the idea that sometimes the most important aspect of intentional questioning lies in not asking a question.
When during our practices do we intentionally not pose a question?
As nurses, we might hold off because the person is not ready to hear the answer. Questions confront people with uncertainties and consequences, possibly long before a person is ready to face them.
Cultural factors can also influence our decision. Is this a culture in which an individual has the self-efficacy to answer? Or is this a culture in which complex questions are answered by elders, a family network, or friends?
Sometimes we hold questions because the moment demands our attention and we cannot be distracted from the focus and energy needed to resolve the crisis. And sometimes we don’t ask because we recognize that current circumstances—the state of knowledge or measurement or analytics—aren’t at a place to deliver a proper answer.
My wisdom for you
Graduation speakers are supposed to impart wisdom. In my life the deepest wisdom has arisen from conversations that began with questions. So my wisdom for you: Ask questions early and often.
Questions are part of your future—whether judiciously asking a question or intentionally withholding one. Your education will provide a solid foundation on which to formulate those questions and the base of a scaffolding on which to hang your new understanding.
So I leave you with a bold direction: Stop knowing so much—and be ready to ask more questions! You are ready to be intentional questioners. Please embrace the role because someday, I may be your patient.