The most successful type of change involves getting your patients to do the work for you; for them to suggest your solution themselves. This involves giving the illusion of control to your patients when in fact you were the one controlling things all along.

In the world of motivational interviewing, “open-ended questions” invite others to tell their story without leading them in a specific direction. Instead of asking a closed question (where the only appropriate response is a “yes” or “no”), open ended questions leave the door open for someone to share their full response to your question.

After learning about this tool in school, I was excited to start using it. I mean, what better way to get a truthful, thoughtful response from your patient than asking a question that doesn’t lead them on or isn’t too specific? The trouble came when I asked my patient, “How have things been?” They then proceeded to tell me their entire life story.

But, but… That’s not what I meant…

Here’s where “calibrated questions” come in, a concept I first read about in Chris Voss’ Never Split the Difference. Calibrated questions are carefully thought out and targeted to a specific problem. This way, your patients have to pause and think about how to solve their problem. 

Whereas closed questions are answered with limited information and open-ended questions can be answered with the whole kitchen sink, calibrated questions fall in between. They are open-ended enough to get your patient to think through their answers but specific enough to the subject at hand.

What I love most about calibrated questions is their ability to introduce your ideas and requests without sounding too pushy. This is because while they are specific, they’re still subject to patient interpretation. In other words, they give your patients the feeling of control!

Okay, enough on the “what.” How do you use it?

Once you figure out where you want your conversation to go, you must design your questions to ease the conversation in that direction while letting your patients think it’s their choice to take you there. Here are some rules of thumb that Voss outlines:

• Avoid words like “can,” “is,” “are,” “do,” or “does.” These words tend to lead to closed-ended questions, when what you want are more thoughtful answers that help you learn more about your patient.
• Start your questions with “who,” “what,” “when,” “where,” “why,” and “how.” The most useful words for your toolbox are “what” and “how.” Here are some examples:
  • What exercise plan works best with your schedule?
  • What about this plan works for you?
  • What might be some barriers to your success?
  • How has your pain affected your daily activities?
  • How can I help make our plan better for us?
  • How can we ensure your success?
• It is critical that you are asking for your patient’s help – your delivery must convey that. It must not sound like an accusation or threat.

When are they most useful?

Voss recommends to use these questions early and often. The earlier and more often you use these questions, the more useful information you’ll gather to help solve your patients’ problems.

On the flip side, be careful how you ask your questions to certain patients! You must develop a good sense of how your patient responds early in your visit. Picture the patient that decides to share their entire life story day-by-day, giving you superfluous information and eating up precious evaluation time. The more likely your patient is to deviate from the topic, the more specific your question should be.

As with all assessment and communication tools, using calibrated questions requires practice. At first, it’ll feel awkward. But soon you’ll find that you will get valuable information about your patient that will help guide your treatment plan and help create a therapeutic alliance to successfully rehabilitate your patient.

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