I never thought that my ideas about how folks become excellent physicians would correspond to advice from a social media marketing guru. However, last week, when I was perusing Seth Godin’s blog  I came across a post entitled “Why ask why?”  and was amazed to find that our philosophical approaches are almost identical.
Seth believes that “why?” is the most important question, and not asked often enough. I thoroughly agree
For years, as I have welcomed medical students to the clinical arena I have encouraged and implored them to ask “why” and to be prepared to answer me if I ask them “why?” Just like Seth, I consider the answer: “Because Dr. Smith told me to” unacceptable.
Here are some “why” questions I specifically encourage:
Why is maintenance fluid maintenance? (In other words, why are you using this formula that was given to you? How do you know it is right for this patient?)
Why did you obtain that test? (So many medical tests are done routinely, but there are no routine patients. This is one reason that medical costs are out of control)
Why is this patient admitted to the hospital? (Sometimes we admit patients for the wrong reasons, such as fear of lawsuit)
Why do we want a consult from a subspecialist? (The answer is NOT because they have an abnormal lab that pertains to that system)
Why do we treat this disease with this medication? (This is where we often receive the “because this is how I have always done it” answer)
The “why?” questions should be asked by patients, parents, students, nurses, residents, pharmacists, respiratory/physical/occupational/speech therapists, social workers, nutritionists, attending physicians, and by the most respected as well as least known professors and pundits. If the “why?” receives a defensive response, then the patient should find a different doctor; the learner should find a different mentor, and the staff should find a different health system, or (preferably) work to change the attitude.
Because I said so.
Wait, that’s not right—because we owe it to our patients and our learners to think critically about every decision we make, to consider alternatives, to not get “stuck” in the routine, and to incorporate the latest available information into our decision making behaviors. We owe it to society to always wonder whether what we are doing is the most cost-effective, the safest, the best action we can take. If there is no good answer to “why?” we need to open an area of research, to find out.
Thought leaders don’t pontificate, they ask “why?” and keep asking until they find the answer.