Everything you say matters, and so it matters what you say

Wise Words on Empathy - from a 4 year old

My patients all teach me a lot. The younger ones are freer to say what’s on their minds and so they sometimes teach me the most.

Over the years, children in my practice have asked some truly memorable questions. There are the standard questions I hear from children in my practice. I’m always ready for these. These are the classic questions like “how old are you, Dr Donovan?”, and “Are you taller than my brother, Dr Donovan’. Then there are the less classic ones - that sometimes catch me off guard - but that always give a smile:

What will you have for your lunch today?

Do you live here in this office too?

How much is my dad going have to pay for the parking today?

Several years ago, a 4 year old with severe hair loss came to see me with her parents. Her visit has still stuck with me all the years. She had verbal skills far above most 4 year olds who come to see me and she was definitely in charge of the appointment that day.

Despite being in great command of the appointment, she agreed to sit quietly while I asked her parents some questions. After speaking with her parents, I told her that I needed to ask her some questions too. I began my questioning by asking her age to which she replied by tucking her thumb into her palm and holding up the classic 4 year old finger count and confidently shouted out her age.

Then I proceeded to ask my second question in my standard set..

“What is your favourite color?, ” I asked.

“Oh Dr Donovan. I don't have a favourite color. I like aaaaaaalllll the colours.”

I smiled and pondered the unexpected answer and then proceeded with my standard package of questions for 4 year olds. “What is your favourite ice cream flavour? …..Who is your favourite superhero? ….. ” Each question of mine was met by a standard template of answers from my little patient :

I don't have a favourite ice cream flavour. I like aaaaaaaaaaallllllllll the flavours.”

I don't have a favourite superhero. I like aaaaaaaaaaallllllllll the superheroes.”

I was trapped in the loop and there was no escaping. She had outsmarted me and she loved the game. I smiled and thanked her for the great answers and proceeded to examine her scalp. About 1 minute into the examination she stopped, stood up and pointed at me, “Dr. Donovan what is YOUR favourite color?”

I immediately replied, without thinking, mimicking her previous template of great answers,

“I don't have a favourite colour. I like aaaaaaaalllll the colors.”

She seemed rather pleased with my answer and proceeded to fold her hands together and look at her parents as though she had impacted me and inspired in me a reasoning that she had truly intended. I figured my response was a good one. We seemed to have made a connection.

Her mother then turned to me and chose to continue the game by asking me “What is your favourite hair problem that you see in the clinic?”

It was a rather unusual question - and one that I was never asked before. But I again immediately replied without much thinking “I don't have a favourite hair problem - I like aaaaaallllll hair problems ”

After examining the child, I sat down again and asked the parents if they were okay with me talking about the diagnosis and prognosis and plan in front of the child or would they prefer one parent take the child out of the room. They felt it was okay to proceed and so I proceeded to explain the diagnosis and more limited treatment options. The little girl waited patiently flipping through the book that her parents had brought into the appointment.

At the end of the visit, I respectfully gave the final question to the child, asking her if she had any questions for me. To my surprise the young girl quickly replied “It’s not nice to like all hair problems because I don’t like my hair problem.” She was serious and after relaying that message to me, she left with her parents.

Although that little girl and I first became friends through our willingness to equally like all colours, our short term friendship broke down soon after from my failure to see things through her eyes.

The little girl’s visit taught me that every single thing we say to patients does matter - whether to a 4 year old, 14 year old or 40 year old. Our patients count on us to pause, take a breath, and answer each of their questions with the same degree of focus, honesty, sincerity and empathy.

Everything you say matters, and so it matters what you say.