Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Blueberry Bushes


A patient’s main concern is sometimes not medical. It can be helpful to ask, “Is there anything we didn’t cover that you’d like to talk about?”  

I was wrapping an office visit and felt like we’d a thorough conversation. But my patient sat stone faced and shifted slightly in his chair. Something was off. I gently asked, “Is there something we didn’t cover today that you’d like to discuss?” 


“Well actually, I do have a silly question . . . when will I be able prune my blueberry bushes?” 


A thorough review in medicine does not include agriculture care. 


“Not a silly question,” I said. 


This is a common event where we nail down treatment for the medical issue and we feel a sense of accomplishment. But that isn’t always the main thing that bothers our patients. How these injuries and diseases affect each person personal. We may cover ADLs but what about their other hobbies or values? These are the things that give them meaning and enrich their lives. The good news is the answers aren’t hidden to us, but we do need to do a few things to create an open environment for the patient to share their personal concerns. 


The standard format for a visit ends with time to ask questions. But this appeal for questions only works if you have created an environment for open communication. We accomplish this with simple changes that take only a couple minutes. Sit down and face the patient. Smile often. Let the patient finish their thoughts. Pause for discussion periodically. Avoid medical jargon and adopt their language. Thank them for their honesty. And ask these two questions: 


1. “What activities do you like doing that you can’t do anymore?” or, “What do you want to get back to once this medical condition improves? 


2. Instead of asking, “Do you have any questions?” say, “Is there anything we didn’t cover that you’d like to talk about?”



My patient and I talked about when and how to safely return to pruning blueberry bushes within the scope of his treatment. I restored this patient’s “why” as well as addressed all medical concerns. When our patients walk out the door, they may worry about the medical details, but instead worry about their lives, hobbies, job, and maybe even who is going to prune the bushes. Ask the right questions and you can seamlessly take a bushel of worries off your patient’s back.









This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.