Learning to Be Comfortable With Questions

When I entered medicine, I thought learning was mostly about finding answers. You study biology, chemistry, anatomy, and disease. You take exams where there is usually a correct answer and several incorrect ones. If you work hard enough, you learn how to recognize the right choice.

Research changed that way of thinking for me.

I began doing research years before I became a nephrologist. At USC, I had opportunities to work in neuroscience and later on the Human Genome Project, studying human genes and how normal cell cycle regulation can be lost in cancer. I also spent time in oncology research involving children with leukemia and bone marrow transplantation.

Each experience was different, but they taught me the same basic lesson. Science often begins when someone is willing to say, “I don’t understand why this is happening.”

That sentence can be uncomfortable for a physician. We are trained to know. But I have learned that admitting what we do not know can sometimes be the beginning of better care.

Kidney Disease Gave Me Bigger Questions

My questions became more focused when I entered nephrology.

During my fellowship training, I became interested in thrombosis and platelet dysfunction in patients with kidney disease. I received support through an NIH-sponsored research fellowship and studied some of the mechanisms that might help explain why people with kidney disease experience serious cardiovascular and vascular complications.

One question kept leading to another.

Why do these patients have different risks? What is happening with their platelets? How might certain receptors affect clotting? What role does inflammation or oxidative stress play?

These were not questions with simple answers.

That could be frustrating. Research requires patience, and medicine does not always reward patience. As a physician, you want to help the person in front of you today. As a researcher, you may spend months studying something without knowing whether the result will ever change patient care.

Is that time worth it?

I have wrestled with that question.

I believe it is, but I also understand the tradeoff.

Research Taught Me Not to Fall in Love With an Answer

There is a temptation in medicine to become attached to what we already believe.

Experience can make a physician better, but experience can also make us overly confident. We see a pattern many times, then we start assuming the next patient will follow that same pattern.

Science pushes against that instinct.

A hypothesis is not a fact simply because we like it. A theory does not become correct because it makes sense to us. We have to look at the evidence and be willing to discover that our original idea was wrong.

That lesson has stayed with me in clinical practice.

Sometimes a patient’s symptoms seem to point in one direction, but something does not fit. Maybe a laboratory value is unusual. Maybe an imaging result is different from what I expected. Maybe the patient’s history makes me reconsider my first impression.

Those moments matter.

Instead of asking, “How do I prove what I already think?” I try to ask, “What else could explain this?”

That is a research question, but it is also a clinical question.

The Laboratory and the Procedure Room Are Connected

My career eventually took me from research into interventional nephrology and vascular procedures.

At first glance, those worlds can seem very different.

Research can involve data, laboratory methods, receptors, platelets, and biological pathways. Interventional medicine involves real-time decisions, imaging, blood vessels, wires, catheters, and procedures.

To me, they are connected by curiosity.

When you are performing a vascular procedure, you still have to ask questions. Why did this access fail? Where is the problem? Is an intervention necessary? What are the risks of proceeding? What happens if we do not intervene?

Technical skill matters greatly, but I do not think technical skill alone makes someone a good procedural physician.

You have to understand why you are doing something.

Better Questions Can Slow You Down

There is another side to this mindset that we do not talk about enough. Questioning yourself can slow decision-making.

Medicine sometimes requires speed.

If a patient is unstable, you cannot spend hours considering every possibility. Training and experience exist partly so we can recognize problems quickly and act.

So how much questioning is enough?

That balance is difficult.

Too little questioning can lead to assumptions. Too much questioning can create hesitation when action is needed.

I have found that experience does not eliminate this tension. It helps you manage it.

There are times to act quickly, and there are times to stop and say, “Something here does not make sense.”

Knowing the difference is part of clinical judgment.

Patients Ask the Most Important Questions

Patients also remind physicians that our questions are not always the only ones that matter.

A doctor might be thinking about kidney function, vascular access, blood pressure, or thrombosis. The patient may be thinking, “Am I going to be okay?”

Those are very different questions.

Working with patients in Los Angeles, including many Spanish-speaking families, has reinforced how important it is to understand what the patient is actually asking. Being able to communicate in a patient’s preferred language helps, but listening matters just as much.

Sometimes we become so focused on solving the medical problem that we forget to ask what the patient is worried about.

That is another form of curiosity.

I Hope I Never Stop Asking Why

My research experience has included neuroscience, cancer biology, genetics, oxidative stress, platelet function, thrombosis, kidney disease, and vascular medicine. Not every project led where I expected it to go.

That is science.

Not every patient follows the textbook either.

That is medicine.

The connection between the two is one reason I still value the physician-scientist mindset. It does not mean every physician needs to spend a career in a laboratory or publish research constantly. It means we should remain curious enough to challenge our assumptions.

Why is this happening? What am I missing? Is there another explanation? What does the evidence actually tell me? Most importantly, what does this mean for the person sitting in front of me?

After years of education, research, and patient care, I have become less interested in pretending that medicine always gives us certainty.

I would rather keep asking better questions.

Sometimes that is exactly how we find better answers.