How Can We Use the “Wow” Factor to Improve Patient Care?

On a recent rainy Sunday afternoon, my wife and I decided to savor this rare occasion in San Diego by taking our 2 daughters out for a walk. While we were busying ourselves with our umbrellas, our 18-month-old, Kayla, stopped us all by pointing and looking all around her. She then exclaimed, “Wow!”

It was a moment that reminded us to savor what we often take for granted. But what does this have to do with diabetes?

Several days later, I looked back and thought, “What if we looked at the world with more of a sense of wonder, of ‘Wow!’” To me, it can often be a short distance from “Wow” to “Why?” Wonder can help cultivate a sense of curiosity. We adults tend to lose sight of this among the crowded calendars that mark the daily hustle and bustle of our work and home lives. From the questions awe generates, can we find new solutions? What if we tried to see things from a patient’s point of view? Would that help enhance that patient’s care and quality of life? Would that, in turn, help decrease burnout for us?

“Wow!” and “Why?” help us shake things up, revisit old problems in a new way, and, ultimately, help create breakthroughs on both an individual level and a more global scale.

1. What “Wow!” can do in the clinic

I think of this as also looking at the world with a sense of curiosity.

• “I wonder if…”
• “Why?”
• “What can I learn about this patient?”
• “Why are the self-monitored blood glucose levels not following a pattern?”
• “What’s holding back a patient from implementing the changes she’s learned about?”

One of my mentors and colleagues, Steve Edelman, MD, opens a patient visit with a question: “What’s bothering you about your diabetes?” Maybe the answer will provide a wow moment, such as the fact that I didn’t know that Ms Smith is struggling working 2 jobs and sees her stress as a major impediment to greater self-management of her diabetes. Or, on a more uplifting note, I didn’t know that Mr Jones recently turned around his long-suboptimal hemoglobin A1c (HbA1c) level by finding a compelling source of motivation: wanting to be healthy enough to dance at his youngest daughter’s wedding.

Encouraging patients and their loved ones to be medical sleuths — to ask why and to put the power of wow to work — can facilitate greater engagement with their diabetes, potentially translating to improved outcomes and, of note, enhanced quality of life.

2. How can we apply “Wow!” to pushing the boundaries of discovery?

Whether we conduct research ourselves or not, we know that asking why can lead to breakthroughs, whether it is elucidating a mechanism of action, discovering an enzyme pathway, or developing a new medication. It can be asking a question no one else has asked or thought of before or even one that is not new. The GRADE (Glycemia Reduction Approaches in Diabetes; ClinicalTrials.gov identifier: NCT02388100) study stemmed from a seemingly simple, yet often pondered and currently unanswered question, “What’s the best medication to use after a patient with type 2 diabetes is no longer controlled on metformin only?” I am always amazed that this study wasn’t conducted sooner!

We must learn, or relearn, to see the world with fresh eyes, with an openness that can lead us to find new solutions to enduring challenges. I would also say that we should involve all parties in designing studies, including patients, caregivers, clinicians in the community, and other individuals outside the medical community. Seeing from multiple vantage points is not easy, but it can enrich efforts to improve tests and treatment from the bench to the bedside.

3. How we can apply “Wow!” in teaching and learning

One of my mentors when I was an undergraduate, Arnold Scheibel, MD, inspired me to become a physician. He would say, “If you can spark one person’s curiosity, that’s a tremendous privilege.” I also consider it an honor to spend 2.5 days a week teaching. One afternoon is devoted to clinic with a third-year medical student, and the other is our residents’ clinic. We also have time to learn during weekly Grand Rounds. We teach, but we’re also continually adding to our knowledge. How can we step into the shoes of that trainee sitting across from us, a younger version of who we were, not that long ago? The previous 2 topics were about focusing on the patient, but what about the learner? How can this attitude improve the experience for the student or resident, and in turn enrich our own never-ending journey of learning?

What have we been missing, taking for granted, or not really paying attention to? Would using wow and then why help? I offer my trainees some advice, for whatever it’s worth: take the time on a regular basis to be grateful for how far you have come, how much you have learned, and the opportunities you have received. Then, give back in your own way.

I don’t think it’s too much to say that recognizing and, of more importance, applying “Wow!” and “Why?” will not only help our patients but also ourselves and the next generation of physicians.

Edward C. Chao, DO, practices at the VA San Diego Healthcare System and is associate clinical professor of medicine at the University of California, San Diego.