“What matters to you?”

In a recent comment in the BMJ Sosena Kebede writes: Ask patients “What matters to you?”. Continuing a pattern of my objections to easy solutions for clinical communication, I am writing this with a plea to the contrary. Please don’t!

The sentiment behind Kebede’s appeal is, of course, admirable. Indeed, I agree with her. She makes a well-rehearsed argument about patient-centred care which focuses around what I, the patient, need and value. The question she advocates is aimed at teasing out those needs and values. And I, of course, should have a say in where we go with my ‘condition’. Moreover, I accept that the question, potentially, opens up the space for a patient’s story. Still, I think, it is counteruseful, as are its equivalents like “What is important to you?”.

In the article we read:

The question “What matters to you?” allows patients to disclose their interests, values, and preferences, and it gives the clinical team a chance to appreciate patients as full humans and not just as recipients of care.

Time and again, clinical communication is constructed in terms of easy and simple (OK – simplistic, really) triggers which, when uttered by the doctor, will result in me just oozing information about my “interests, values, and preferences”. It’s as if revealing my soul and life to you were so simple and easy, just because you ask me this incredible and fantastic question of what matters to me. Can we get real?!

It’s noteworthy that the question is to get me to ‘disclose’ things. And so, I shall be saying things which are potentially secret, private. Something I might prefer to keep to myself. But then the doctor waves the magic wand and hey, presto, off I go disclosing. The other interesting word is ‘allow’. Your question allows me to disclose, as if I wanted nothing else. I also thank you very much for the offer to appreciate me as a ‘full human’. Not certain what it is, but I am touched.

So, as a patient and a linguist, I would l like to point out that questions don’t work like that. Believe it or not, even doctors’ questions have contexts and there are doctors to whom I would not reveal last year’s double parking for a minute! In other words, it takes considerably more than one question to tell you anything beyond the current problem I see you with. I need to trust you, probably, like you. I need to think that ‘disclosing’ makes sense, that you do not simply pay lip service to the current set of communication procedures. And probably a few other things.  And that’s precisely the context in which you ask me your question. Incidentally, I always find it bewildering to see clinicians’ surprise when I tell them that I actually can find them nice, obnoxious, attractive, interesting, dull, stupid, bright and so and, and the like. I can (dis-)like their spectacles, shoes, sweaters, shirts or bracelets.

Let me put it differently, asking the question “What matters to you?” doesn’t even begin to get me to tell you what matters to me. And I really wish you, my doctor, stopped thinking of me as a book which simply opens at your say-so.

Now, the question “What matters to you?” is very general. Yes, you could argue that the context of an interaction with my doctor makes the answer easier, yet, the article actually does confirm that it is meant to be just about as general as it sounds. So, what might matter to me is to have more money, more hair on my head, speak Mandarin, and run marathon below 3 minutes per kilometre and the black belt I am now unlikely to achieve (in either of the martial arts I have practiced). This is what matters to me, but do you really want to know it?

Incidentally, what really (like – really) matters to me, I am not prepared to share publicly. In fact, I am not prepared to share most of what really matters to me with my GP, whom I like and respect. It’s none of his business. I would actually find the question quite intrusive, to be honest.

Moreover, if these responses are not responses you want, then what exactly are you asking me? And this is the other side of the medical view of clinical communication I often find and dislike.  As you ask me your question, I am supposed to know what you mean. I am supposed to understand what exactly I should say. The problem has been addressed by Justyna Ziółkowska on the basis of data from psychiatric interviews (here you’ll find the link to her article).

Analysing the form of doctors’ questions, she shows that they do not only construct patients’ problems differently, but also ask questions which are unlikely to be understood by their patients.  I would argue that questions such as ‘What matters to you?” are precisely questions which are mostly confusing. This is also why they should be avoided.

I’ll end with a story. Some time ago I wrote about a man in his pyjamas whom I interviewed. He was hospitalised after a suicide attempt. It was the second time he tried to kill himself, after his child had been killed by a car. The interview was surprising. First, he talked about his daughter – there was a smooth narrative that he offered me about how much he cared and still loved her. Then the interview changed – he spoke of his inability to find a job, to care for his family.

Let’s speculate what he would have said if asked what mattered to him? I would guess the answer would have been something like: my daughter and my job. And so, what would you, doctor, offer him? His daughter’s life or a job? Or perhaps a spiel about unrealistic expectations in the 10 minutes you will have for him?

Clinical communication does not and cannot depend on asking ‘the question’. Yes, there are good questions, there are bad questions, but none ever can guarantee an answer. Patients are not people who simply are triggered to say how it is, and say it all. It’s worth remembering that. How about just having a conversation with me?


  1. Really thought-provoking! I do think a focus on what matters to me and not just what is the matter with me (pathology) is important as far as my long term mental health is concerned but if you are suggesting this as a conversation opener I completely agree it won’t work! Maybe because I have suffered from mutism and often relied on my GP’s or therapist’s patience to wait and wait to get any answer at all to opening questions. Sometimes the best question then would be Do you feel able to talk today? Asking any question offering the opportunity to ruminate about the implications for me of the infinite variety of possible responses would be quite the wrong way to go! Much of my time in consultations has been spent analyzing the hidden meaning behind doctors’ questions, which of course has not helped me respond! On the other hand long-term illness (there has to be a silver lining!) has meant I have gradually been able to trust my therapist with that private information about what matters to me. So for me that question works best when never or rarely asked directly but always there as an attitude in the background prompting other more useful questions, and maybe daring answers!

    Have you written anything on the trials of completing annoyingly worded multiple choice or numerically rated measures (my expletive deleted)? That would interest me!

    1. Dariusz Galasinski

      Thank you for your comments – I agree with them. First, yes, the context in which “Do you feel able to talk?’ might, indeed, be the most appropriate. More generally, something that I have been trying to say many times, is that there cannot be any rules. And this is also why clinical communication is so difficult.

      I have written on the BDI.

  2. Interesting piece, thank you. My experience as a person with mental health problems has shown me that doctors, family, friends and colleagues often assume they know what matters to me, and that for me is frustrating and alienating. I would prefer to be asked. As a GP I find the best tactic is silence – let the person talk, and avoid interrupting for as long as possible. As Osler said ‘listen to the patient (s)he is telling you the diagnosis..’
    As you hint, though, it’s all about the relationship and the context, and there are at least two sides to that!

  3. As I am going through some medical treatment at the moment, the question I would most like to be asked is would I like to talk. Would I like to open up to them, would I like to tell them anything, am I ok or would l like to talk would do it. The nurses in the breast cancer unit are very nice, as everyone keeps telling me, but I don’t want to talk to them. I’m not in denial but I don’t like the assumption they make that I want to talk to them in that appointment, at that moment. It has consistently been really intrusive, and it doesn’t help that I am quite often getting dressed after an exam so am ambushed.

    Most of the time I don’t really tell them anything but when I am avoiding telling them anything, I sound bright and breezy, which always leads to them saying something really stupid like I have the right constitution to get through this. I don’t know what the right constitution for cancer is btw. They also all laughed at me continuously when I carried on working, which was very important to me, during what was a long diagnostic process. Sometimes there has to be some normal somewhere and goodness knows why they couldn’t hear that work was very important to me. I kept being told I should look after myself and have ‘me’ time. I didn’t really need more time to worry about what the diagnostic process was finally going to reveal.

    If those nurses had done what they said they were doing, which was getting to know me and supporting me, they might have realised that what I needed was not what they were doing. They didn’t though, they had a cookie cutter template and I was probably awkward because I didn’t fit it. If I sound ungrateful I am, I would be grateful for people asking me before they talk to me about my cancer, they are professionals, I am of course completely forgiving of anyone in my personal life who does or say anything.

    I also have absolutely no say in my treatment plan so am happy to talk to the doctor when there are decisions to be made about which order we do things in etc. but anything else would be a token gesture, so I don’t need it. I’m happy that they have a multidisciplinary meeting about me filled with lots of people who know a lot more about breast cancer than I do, as long as they explain it all to me. The doctors don’t really want to know about me outside that discussion, sometimes I do tell them something about my treatment which is important to me, and we can talk about that.

  4. I think this well -written article was interesting reading! However, I cannot seem to grasp what the problem is, Dariusz. Or, even more so, what it is you actually want.

    You are, amongst others, referring to the following quote:

    “The question “What matters to you?” allows patients to disclose their interests, values, and preferences, and it gives the clinical team a chance to appreciate patients as full humans and not just as recipients of care.’

    You comment on this quote, highlighting that

    “if revealing my soul and life to you were so simple and easy, just because you ask me this incredible and fantastic question (…). Can we get real?! It’s noteworthy that the question is to get me to ‘disclose’ things (…) which are potentially secret, private. Something I might prefer to keep to myself. ”

    I get the impression, that your perspective on the matter blows the actual issue out of proportion and context.

    Interestingly, you refer to the importance of context yourself, writing

    “Believe it or not, even doctors’ questions have contexts and there are doctors to whom I would not reveal last year’s double parking for a minute! ”

    Wouldn’t you think that neither the doctor nor other health professionals are asking you to reveal your soul, secrets and history of double parking, and rather simply attempt to assess together with the patient what services are needed, rater than imposing offers on the patient that do not make sense to the individual?

    As the quote states correctly, asking “What matters to you?” allows(!)(would put it in italics if I could) for the patients to open up about preferences, but there are no strings attached. It is an opening. And, as I can see from the very first comment, and from a wide range of research evidence, many patients need (!) to be heard and having the opportunity to raise their voice in matters that concern themselves.

    Correctly enough, this is unlikely to appeal to the patient who needs medicines against a cold. But that patients with chronic fatigue, with cancer, which MS this patient is likely to go through a long series of different treatments, offers and encounters with varying health professionals – a procedure that might exceed their reduced capacity, in the first place. Asking: “What matters to you” is an opening to sort out priorities with the patient. Maybe a family counselor is much more needed than a physiotherapist, to get life running smoothly again. I guess, THIS is what this type of question is meant for.

    And if it doesn’t appeal to you – the patient with a cold, an allergy or a broken leg – well, you have the full right to nod your head, smile politely and reply: ” I think I am good, as long as I get my meds and a sick-leave note, thanks!”

    I still don’t get why you seem to get so upset about health professionals trying to be more considerate.

    What is wrong with health professionals attempting to shift perspectives from working with “cases” to working with “people”?

    The sentence you write:

    “And I really wish you, my doctor, stopped thinking of me as a book which simply opens at your say-so”

    particularly triggered a memory of myself, back when I was a teenager. I was mad at everybody asking: “How are you”, or talking about the weather, because I could not stand the smalltalk. I thought they would not mean it anyways.

    By now, I changed my view on that. Firstly, I think you are right with your point and very illustrative example of the patient you interviewed: It is important to let a conversation unfold naturally. But, secondly, also, we just have to start somewhere. And take it from there, together. Asking: “What matters to you” is at least an opening to the conversation you ask for.

    I think it is impossible to ask a foreign professional to talk to you as if he “meant” it. This is what your family and friends should do.

    So if it is the fact that a doctor “throws phrases at you” that makes you so mad, my reply to this would be as simple as: Relax.

    We are all just human. It is incredible difficult to talk to someone you don’t know. So when health personal revert to something they have learned in order to adapt the services to the patients, I would give them credits for it. If I’d feel they aren’t on the right path, I’d make a counter suggestion.

    We should, by all means, appreciate the opportunities that the “new procedure” of asking that question gives to create more responsive systems. Patients have their share in good communication, too. Take the responsibility to steer the conversation in the desired direction if the one proposed does not seem the right one. After all, we are grown ups and have the autonomy to do so.

    And when it comes to your example of the patient you talked to – maybe the doctor wouldn’t have offered him a job, that seems very unlikely, indeed. But he could have referred this person further in the system, be it social services, or a psychologist. He could have digged deeper and figured out what he could do for the patient. Providing and mediating services that enhance health is, after all, his job.

    As a linguist it might be difficult to refrain from verbatim analysis of any sentence. But maybe we should indeed not regard the “fantastic question” just as verbatim recommendation, but as general encouragement and broader movement towards adapting health services to patients’ needs.

    So I think, it would be an uplifting alternative to regard the question of “What matters to you?” as an opening to create bridges between patients needs and health services. – And as an opportunity which patients can choose to appreciate or discard – rather perceiving it as unwanted one way road one has no impact on.

    I am confident about the ability of health personal to rephrase the wording in accordance with the context, to make patients feel comfortable in answering it. If they succeed in doing this, positive changes will happen in the system-patient relation. And to be honest, I think, “What matters to you” is exactly what you asked the patient yourself – you just might have used other words.

    1. Dariusz Galasinski

      Thank you for your comment – it is too long to offer a detailed response. I will, however, raise a couple of issues.

      First of all, what doctors say doesn’t make me ‘mad’. However, I reject the ‘Relax’ attitude. No, it’s not for me to ‘relax’, it is for doctors to reflect on what they say.

      Second, while I admire your trust in doctors’ abilities to rephrase, I wonder what it is based on. I cannot claim to know all literature on clinical communication, I am, however, quite familiar with research on the psychiatric interview. I have also done such research myself. Unfortunately, both sets of research suggest that your confidence is rather unfounded. And if anything, research so far suggests that at times asking a simple, unleading question goes way beyond the capacity of some clinicians.

  5. You make some excellent points – we can’t expect people to just open up like a flower on command, especially if it is just to satisfy our curiosity or so we can say that we’ve ticked the “communication” box, leaving us with a warm inner glow.

    In a lifetime of watching medical communication from both ends though, it has struck me how crap we are at it, especially the listening part ( i.e: 90% of it ).

    At least asking is a start, one all too often omitted, leaving the doctor in control of the thread of the conversation ( median time to first interruption by doctor in one study was 12 seconds). Can’t get a lot out in 12 seconds.

    Asking the right way at least offers the opportunity to shift the balance of power in the conversation, giving the patient some chance of getting out what he/she needs to. It also signifies a degree of respect and encourages greater disclosure later if this is what is needed.

    A general “what is important to you?” doesn’t cut it though – all conversation is contextual and one has to get this right and allow the patient to define much of it for himself/herself.

    1. Dariusz Galasinski

      We agree, Andrew. Asking is the right way to start and you could argue that I am nit-picking. And, if pressed, yes, I would say that “What is important to you?” is better than nothing. At least it shows commitment to listening.

      But then, we must wonder what is the baseline from which we start. And perhaps this is a debate that should happen before any critique happens.

  6. Interesting article. As a patient, I feel the opposite. I wish they would ask.
    Although I’ve never been asked this question, I’ve taken it upon myself to tell some doctors what matters to me.
    For example, it’s often assumed that time with the family is top of a patient’s list, but for me it’s the purpose of work.
    They’ve sometimes had trouble hearing it, but it’s my life and my priorities.

    1. Dariusz Galasinski

      I wrote as a patient. I have no trouble at all with doctors considering and acting on my priorities. It is my life – I agree with you. I object, however, to a question which is supposed to be a magic wand.

      I firmly believe that doctors should ask questions about what I want from therapy etc. But it does matter how you actually do it.

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