Asking patients, “What are you most worried about?” can bring to light unspoken concerns and allow fears to be addressed.
While working in the pediatric emergency department as a resident, I signed up to evaluate a girl with a fever. I walked into her exam room and noted the lights were off and she was in bed, scared, with her mother beside her. I introduced myself and asked, “What brings you in today?”
Her mother shared that she’d a couple of days of fever, cough, runny nose, and fatigue. After completing my assessment, I concluded she had a viral infection. I explained the causes and typical length of symptoms, then finished by recommending supportive care. The girl listened intently, then sat up at the end of my summary. She asked, in shock, “You mean, I’m not dying?”
“No, you definitely are not dying,” I reassured in a calm voice. “Your body is just fighting off an infection, which is why you don’t feel great.” She smiled as I left the room to find her some Gatorade.
Not every patient volunteers their worst fears. They may feel embarrassed or think their beliefs are inconsequential. Yet their fears, addressed or not, shape how they see their illness and their healthcare experiences. Fears matter. After seeing many parents bring children into the emergency department for non-emergent conditions, I started asking questions to help me understand how they saw their child’s condition and level of care. Sometimes, a lapse in insurance or limited clinic hours made the emergency department more accessible. Other times, the parents and child were simply afraid. I started asking a simple, but profound question, “What are you most worried about?”
Once given the opportunity to share, parents and patients readily confided their worst fears. The mother of a child with lymphadenopathy was afraid of cancer after a relative was recently diagnosed. A child with UTI worried about diabetes after their dad had a similar presentation.
The question allowed me to address fears and explain the likelihood of their concern. Most of the time, I was able to alleviate them through reassurance. I even had a video interpreter compliment me by saying, “I can see that the mom’s disposition calmed with your explanation. Thank you for taking the time to ask.” If their concern was on my differential, I told them why and how I would evaluate it further.
As an adolescent medicine fellow, I now anticipate common fears based on chief complaints and include them in my routine counseling. I try to stay up on the latest contraceptive myths, describe the role of family history in PCOS and endometriosis, or reassure about future fertility. I remind myself constantly that as a clinician, I have the privilege of answering my own fears or easily finding someone who can. By starting this conversation for my patients, I offer greater knowledge about their health and confidence in their healthcare. Fundamentally, they just want to know, “Am I or will I be okay?”
This piece expresses the views solely of the author. It does not represent the views of any organization, including Johns Hopkins Medicine.