Does this course of action advance my interests?
Is there a calling, a bigger purpose?
Does it feel right—is it important, consistent with my values?
Do I have the passion to do this and stick with it?
Can I define “success”?
Do I have the tools to achieve it?
Have I calculated costs and benefits, risks, rewards, and alternatives?
What are the consequences for my emotional, intellectual, and spiritual well-being?
Would the people closest to me think this is a good idea?
If this ended up in my biography (or obituary), would I be proud to see it there?
As the Bill and Melinda Gates Foundation considered its campaign against malaria, the answers to their strategic questions pointed to a need, a capability, and a plan that justified a massive global campaign. They have since worked with doctors and scientists, governments and nongovernmental organizations (NGOs), community organizers and ordinary citizens to make significant progress against a deadly disease. Big and bold and ambitious, their all-in strategy produced results that justified the cost and the risk. Their strategy, well considered and executed, attacked the right problem and was built on the right questions.
CHAPTER 4
FROM THE INSIDE OUT
Empathy Questions
I SAT DOWN WITH four young moms. They arranged themselves in a semicircle so we could all see each other. They were polite, soft-spoken, nicely dressed, and anxious to talk about themselves and their children. A diverse group—black and white and Hispanic—all of them were single moms and receiving some form of public assistance.
?
I was there to do a story for CNN on welfare reform from the perspective of those receiving the benefits—the people we don’t hear from very often, the people we talk about, but seldom with. I wanted to hear about their lives and explore with them how the proposed changes would affect them. The welfare reform law, known formally as the Personal Responsibility and Work Opportunity Act of 1996, sparked heated debate and controversy. It placed time limits on welfare benefits, required recipients to find work, tightened child support enforcement, and tried to discourage out-of-wedlock births by limiting benefits for young single parents. I had heard an endless parade of politicians and experts sound off on the issue. But I was curious: how did these proposed changes look through the eyes of the people who would be directly affected by them? So I asked.
What difference will this new law make?
What kind of job do you want?
How will a job help you make ends meet?
They all said a job would improve their lives and their finances. A job would give them self-respect and a steady income would help them be better parents. But they still needed to take care of their children. They still needed healthcare. They worried about whether their paycheck would be enough to feed the whole family. They wanted to work, but they had valid concerns—and a lot of questions.
As the conversation unfolded and I learned about their lives, I discovered a much more complicated reality than I had imagined. Three of the women had struggled with alcohol or drug issues. One had six kids, including a son who was born with a heart defect and needed frequent medical care. None of these women had gone to college. One said she could barely read.
One of the moms told me about a job interview she had coming up at a local hospital. She was excited and preparing for it. What was the job? I asked. Working in reception or something, she replied. What did it pay? Minimum wage, she thought. How would she afford childcare on minimum wage? Would she have healthcare? How would she get to and from work? She had no idea.
As the conversation unfolded, I realized that the real story here was how much we didn’t know and couldn’t imagine. These women lived fractured and difficult lives, filled with struggle and pain, sometimes of their own doing. I did my best to capture the conversation, but I wished the public could have been there, asking these questions and hearing the answers for themselves, because these women—despite every expectation and stereotype—were inspiring in their determination. You got a different perspective if you asked:
What do you see when you wake up each day?
What are you feeling, fearing, and thinking?
What do you want for your children?
The questions that have always interested me the most are the ones that explore people as three-dimensional beings, each with a unique and layered story. They are questions that mine the most complex human elements, revealing depth of soul and experience. They are questions that foster understanding of someone you don’t know or who is very different from you.
These questions—empathy questions—explore what makes people tick, think, fear, and feel. They focus unselfishly and spring from genuine interest. The simple act of asking, of listening without comment or judgment and letting a silence linger or a free-form thought coalesce, invites a person to reflect or think out loud. It might even prompt a revelation.
Empathetic questioning helps you connect with a friend who is going through a divorce, a family member who has cancer, a teenager who is struggling with grades and social hierarchy, or a welfare mom. Use this line of inquiry when a colleague needs to talk through an argument at home or politics at the office, or when you want to reach out to someone who comes from a different place, background, or perspective.
In this chapter, I explore empathetic questioning through the prism of example and from the perspective of those who’ve studied it and done it for a living. They know how to use questions to enhance trust, reinforce relationships, and improve our understanding of ourselves. This form of questioning pays off in a number of ways. Research shows empathetic bosses inspire more productive workers. Empathetic doctors are more effective. A variety of studies has linked empathy to better health outcomes and lower stress levels. A study published in the Journal of the Association of American Medical Colleges in 2011 found that diabetes patients did a better job regulating their blood sugar when being treated by empathetic doctors. Other studies have found that cancer patients had greater trust in doctors who responded to them empathetically and reported less depression and better quality of life.
Using questions to establish empathetic relationships involves seeing and asking from another perspective. Ask to:
Try new shoes. Empathy involves taking the perspective of another person. What is he thinking? How is he feeling? If you switched places and stood in his shoes, what would you see?
Leave running room. Start with big broad questions to get people talking. Invite them to engage on ground where they’re most comfortable and most familiar.
Listen beyond words. The deeper you go, the more you need to listen for cues and tone and mood. Pauses and hesitation have meaning, too. So do body language, facial expressions, and eye contact.
Establish intimate distance. Convey compassion and interest. But maintain enough distance and detachment so you don’t judge and can offer objective questions or advice.
The Good Professor
Helen Riess is a clinical professor of psychiatry at Harvard Medical School. She studies empathy and teaches doctors how to incorporate it into their work with patients. I got to know her through the Middlebury College board we both served on. From the moment I met her I was struck by her instinctive ability to listen intently and to represent diverse viewpoints with depth and sensitivity when she spoke at our meetings. When she mentioned student life, for example, she conveyed a special awareness of the pressures college students face, engulfed by technology, plugged in to always-on texting, dealing with mountains of debt and uncertain employment in a hypercompetitive global economy.