Ask More: The Power of Questions to Open Doors, Uncover Solutions, and Spark Change

CHAPTER 2

SOMETHING’S NOT RIGHT

Diagnostic Questions

THERE ARE DAYS REPORTERS DREAD, but they come with the territory. A rumor, a phone call, and then a pit in your stomach, no matter how seasoned you are. A passenger jet has disappeared. Air traffic controllers lost contact with the crew. The plane vanished from radar screens. Airline and aviation authorities are racing to figure out what’s gone wrong. So are we.

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In the newsroom, we are scrambling, preparing to go on the air with the story. What exactly will we say? What do we know? Where will definitive information come from? And when? We deploy reporters. We’re all over the FAA and the FBI and the airline. We’re using new flight-tracking apps. We’re working sources, contacting anyone who might have heard anything. We brace ourselves for the most perilous time in live TV—that period after something happens but before anyone in authority can confirm what actually happened. If we get it wrong, we spread misinformation, scare innocent people, and may even affect the actions of first responders. We tarnish our credibility and outrage our viewers.

A lot of our work will unfold in real time, right in front of the audience as we ask the questions that track what’s going on and what went wrong.

What airline and flight number?

How many were on board?

When and where did it disappear?

These are the first harried questions we ask in those early, frenzied moments—the who, what, when, and where questions of a breaking story.

Was there mechanical trouble?

Was anyone on a watch list?

What did witnesses see?

We need to know what happened and what went wrong. Until those questions are answered, the rest of the story will remain a mystery.

What’s the Problem?

Fortunately, most planes land safely, and life does not unfold in a TV newsroom. But our need to identify problems so we can act on them is an ingredient of daily existence. The reporter’s rapid instinct, like the clinician’s expertise in connecting symptoms to illness, is a skill you can develop and incorporate into your questioning to become better, faster, and more precise when you have to diagnose a problem. Whether it’s a life-threatening condition or a leak in the basement, a pain in the shoulder or an issue at work, you have to figure out what the problem is before you can do anything about it. You have to ask the right questions, accept bad news, and roll with the unexpected to get the answers you need in a timely fashion.

Since human beings first stepped out of our caves, we realized that if we were to survive, we had to identify peril and then avoid or overcome it. That still holds true, although these days, with Wi-Fi in our caves, we often call the experts. Still, we can hone our skills so that our diagnostic questioning is sharper. We can be better questioners of the doctor or the mechanic or the boss when they think they have the answers to our problems. We can challenge our political leaders when they speak with certainty about a simple problem and an easy solution.

Diagnostic questioning is the ground floor of inquiry. It is the foundation on which other questions are built. It pinpoints a problem and provides a roadmap for a response.

What’s wrong?

How do we know?

What are we not seeing?

What should we do?

Diagnostic questioning identifies a problem then burrows down to its roots, especially when those roots are not instantly obvious.

Your tooth is killing you. You go to the dentist. She asks where it hurts, when it hurts. When you chew? When you drink? She taps, pokes, and applies cold water till you leap out of the chair. Oh sorry, did that hurt? Yes, you grunt, through the junkyard that litters your palate. She says the problem is this other tooth. You’re feeling “referred pain.” An X-ray confirms it. A filling fixes it.

Your company recently introduced a new product. It isn’t selling. Everyone thinks it’s a flop. You’re not so sure, so you hire some consultants to figure out what’s going on. They conduct focus groups. They ask lots of questions about this product and similar ones. They discover that people actually like it and several of them say they’d buy it—if they knew about it. Turns out the marketing was the problem.

Diagnostic questions, whether they are directed at a company or a cavity, progress systematically to describe the problem and identify it.

Connect symptoms and specifics. Start with big, broad, what’s-the-problem questions and then narrow down, zero in. Get past the generic to identify the symptoms and describe related observations in detail.

Ask for the bad. Don’t duck the issues or avert your eyes. Ask direct questions in search of direct answers. It may get ugly, but if you want to fix a problem, you have to acknowledge it to deal with it.

Study history. Look back. Ask about similar experiences, events, and patterns. They provide a baseline. Look for similarities to other situations.

Ask again. The mere existence of a problem means there is something unknown or unanticipated. To be sure you’re on solid ground, ask several times and several sources. Confirm and corroborate.

Challenge the expert. We rely on experts to diagnose our disease. But that doesn’t mean they’re right or that they’re off the hook in explaining what’s going on. Before you accept a diagnosis, ask what it is, what it means, and where it’s coming from. And reserve the right to get another opinion.

“Miss Nosy”

The first step in diagnostic questioning involves knowing what you’re dealing with. Teresa Gardner is an expert at that. She’s been celebrated by her peers, which is how I heard about her and tracked her down, and she’s been profiled on national television. Fearless, tireless and endlessly resourceful, Teresa works in one of the most impoverished parts of America.

A nurse practitioner who makes her rounds through the hills and hollows of the Appalachian Mountains in southwestern Virginia, Teresa deals with what she calls “human train wrecks.” Many of the people here are poor and chronically ill. They lack access to jobs and healthcare. Unemployment rates in many areas are twice or more the national average. Many eat poorly, get inadequate exercise, and neglect themselves in the scramble to make ends meet.

“It’s an area of desperate need. But the people here are such good people,” Teresa told me. Most are hardworking and proud. “Our patients are some of the nicest people you’d ever meet. They’re down on their luck,” but, she confides, “sometimes we have trouble getting people to accept help.”

They need the help. Residents in this part of Appalachia experience disproportionately high rates of heart disease, diabetes, and pulmonary disease. Some counties report twice the early death rates as the rest of the state. Teresa spends her days on the move. Responding to the bottomless pit of need, she took her practice on the road, in the early years driving around in a beat-up old Winnebago called the Health Wagon. Her patients often had not visited a medical professional in years. But Teresa welcomed them with open arms and warm spirit, examined them, listened to their stories, diagnosed their illness, and prescribed their medication.

She used her questions like a scalpel, short and sharp, to cut to a problem to identify and try to fix it. She started with open-ended questions to get people talking and to prompt a description of the problem.

How are you feeling?

What are your symptoms?

How long has it been like this?

Teresa asks her patients about a lot more—their work and their home, their families and their lives, how they’re eating and what they’re drinking. She listens for clues pointing to the root of the problem. As she asks, she brings instinct, experience, and expertise to bear. She’s been practicing since she was young.

Teresa grew up in this part of the country, in Coeburn, Virginia. She shared a tiny room with her sister in the trailer that was the family home. Her father worked in the mines, her mother in a sewing factory. Her dad had a bad back, and some days the pain was so acute, he would fall out of his truck at the end of the day and crawl to the front door.

While the family didn’t have much, they had more than many, and they helped where they could. Her grandmother, “Mamow,” a plump woman who lived nearby, opened her home to feed and occasionally house sick neighbors, some suffering from tuberculosis. Teresa’s mother took meals to the local hospital. Teresa volunteered at the hospital, too.

A curious child from the time she was little, Teresa peppered her mother with questions about how things worked, where they came from and why. She asked about places and people. Her mother nicknamed her “Miss Nosy.” Teresa took her inquisitive nature to school. She recalls the day her sixth-grade teacher, Mr. Bates, drew a heart on the blackboard and started explaining how it had chambers and valves and pushed blood out and through the body. She was mesmerized and wanted to know more about how the heart worked. How did it know how much and how fast to pump? She developed an interest in science and started reading magazines, books, articles—anything she could find about medicine and biology.

She became the first in her family to go to college and ultimately earned a doctorate in nursing practice. Then she came home. She wanted to work in the place where she was raised and where she knew her help was needed.

The Mystery Patient

Trekking across this complex terrain of geography and human need, Teresa elicits vital information from people who are often reluctant to talk. Her warm Virginia accent softens her questions, but they are nonetheless deliberate and focused. Teresa expects a detailed description of what hurts and where. She seldom wastes time or words. Often the problem is buried deep.

Teresa pulled the Health Wagon into Wise, Virginia, shortly before lunch one day, and a woman climbed aboard. She was short and overweight and in her early twenties. As usual, the first question was big and open and warm. With a smile she asked:

How are you doing today?

Not well, the woman said. Her head hurt. She was feeling tired and weak. She felt confused, disoriented. Teresa asked about her past health issues. The woman said she’d suffered from high blood pressure, chronic weight issues, and diabetes.

Teresa suspected the woman was having a diabetic attack. Her questions grew more specific and urgent, homing in.

What medicines are you on? What dosage?

When was your last insulin injection and last meal?

What are your other symptoms?

How long have you had diabetes? Is it Type 1 or Type 2?

When was your last lab work?

What has your insulin regimen been for the past few days?

The answers came in short, hesitant responses. But they added up. A blood test confirmed it: The patient was suffering from hyperglycemia. The treatment for diabetes and high blood sugar is straightforward. Strict diet and carb counting. Insulin, closely monitored. Regular doctor visits. The patient failed on all counts. She was taking insulin but wasn’t sure of the dose. She hadn’t been to a doctor in two years. Teresa wanted to know what was going on and why.

“When we talked to her, it wasn’t obvious at first,” Teresa explained. “But parts of the story were familiar. She worked two jobs, about sixty hours a week, but neither provided health insurance.”

Teresa asked the patient where her insulin was coming from. Hesitantly, the patient acknowledged that her father, retired military, was a diabetic, too. He got his insulin through the Veterans Administration. The patient paused again, looked down, and continued. They had been splitting it.

It was a shocking revelation, though Teresa had heard worse. Teresa spoke slowly and directly, telling her patient about the importance of monitoring herself and her diet, and the potentially deadly consequences of sharing her father’s medication. She wrote a prescription and advised her patient how to get insurance coverage so she could pay for it.

Teresa’s questions effectively identified symptoms and cause, allowing her to plan the best treatment going forward. For now, at least, this young woman and her father would get the medicine they needed to treat the disease they both confronted.

Bad News Is Good News

If you’re going to be an effective diagnostic questioner, you have to embrace something a lot of people would prefer to avoid: bad news. Nurse practitioners like Teresa Gardner look for bad news. They collect information with one purpose: to diagnose a problem so they can treat it. They need to know what’s wrong. Reporters are drawn to bad news, too; that’s their job. If that plane went missing as a result of a security lapse or because the hydraulics failed, they want to expose the problem and break the story. They look for power that’s been abused, money that’s been wasted, and investments that are Ponzi schemes.

If you’re going to ask “What’s wrong?” then you have to embrace bad news. It’s why Steve Miller, a renowned investor and corporate turnaround artist, was in such demand and paid so much money over the past three decades. His book, The Turnaround Kid: What I Learned Rescuing America’s Most Troubled Companies, tells his story of looking for bad news. A veteran of the auto industry, Miller can spot a wreck a mile away.

Why is this company in so much trouble?

Where do the problems originate?

What isn’t working?

Miller asks for the bad, and then tries to outsmart it. He listens for explanations, not excuses. When a mutual friend offered to introduce us, I eagerly accepted and booked a trip to New York City to see him.

Miller cut his turnaround-kid teeth alongside legendary Chrysler CEO Lee Iacocca. Burdened by high labor costs, poor quality, and uninspiring design, Chrysler faced extinction when superior Japanese imports began flooding the American market. As Chrysler’s financial answer man, Miller helped put together that historic federal bailout that saved the company. After a falling out with the charismatic Iacocca, Miller left Chrysler and went looking for other endangered corporate species. He helped rescue trash giant Waste Management. He led Bethlehem Steel through bankruptcy. He salvaged what he could of auto-parts manufacturer Delphi.

Miller’s approach has always revolved around fast questions, fast answers, and decisive, often painful action. Time has never been on his side. Sprawled in his office on Park Avenue in Midtown Manhattan, Miller told me that when companies call, it’s usually because their situation has gone “from troubled to desperate.”

When he takes on a challenge, he brings a fiercely competitive survivor’s instinct and an outsider’s eye to the job. “I like to say I’m fearless and clueless.” He starts by looking for the problem that was the core threat to the business. “I do not regard myself as the answer man,” he says. “I am the question man …”

Typically, Miller spends the first few weeks meeting with people—encouraging them to tell him what’s wrong, what doesn’t work, where the brick walls are getting in the way. After he asks about the past, he wants to know how people see the future.

When did things start going wrong?

What have you learned?

How do you think we fix it?

He explained to me that his biggest professional challenge was as CEO of Delphi, the auto-parts behemoth that had once been part of General Motors. The Delphi Corporation was a $28 billion company, hemorrhaging money when Miller took it over in 2005. Ultimately, Miller took the company through Chapter 11. At the time it was the biggest bankruptcy in the history of the American auto industry. An ugly, nasty, and exceptionally painful process, at times it seemed there was nothing but bad news.

Delphi had grown into the biggest auto-parts maker in the United States. By the time Miller walked through the door, the company had diversified into too many side ventures. It had lost focus on its core products even as global competition got fierce. It was buckling under huge legacy costs of healthcare and union pensions that it inherited when General Motors spun off the company six years earlier. It was paying unionized workers up to $75 an hour in wages and benefits. Workers could retire at age 48 and keep their healthcare for life. Whenever the company closed a factory, it paid laid-off workers indefinitely until they got another Delphi job, a policy that cost the company $400 million a year.

Miller told the Wall Street Journal at the time that labor costs were “roughly triple” what any other unionized American auto supplier had to pay. He wanted to know:

What got us into the ditch?

What happened to the business plan?

Over dinner at the Frankfurt Auto Show, Miller recalled, he asked Delphi’s international corporate customers to critique their experiences. It didn’t take many rounds of schnapps for the horror stories to start flowing. They complained that Delphi had become a plodding, distant, tangled, bureaucratic nightmare of a company to work with. Getting a new braking system to Mercedes-Benz, for example, required sign-off from multiple divisions in different countries. Decisions took forever. The supply chain was broken. It was no way to run a competitive business. “It meant we were paralyzed,” Miller told me.

In his book Miller compared himself to a surgeon and described Delphi as a “desperate patient who waited too long to seek treatment.” He concluded that major surgery was required. Five months after his arrival, Delphi filed for bankruptcy and began its painful reorganization. Miller closed twenty-one of twenty-nine factories, putting four out of ten workers out of their jobs. He forced major wage concessions on the United Auto Workers (UAW) and unloaded most of its legacy costs in worker healthcare and pensions. He moved the company away from manufacturing old-style, low-profit parts—chassis, brakes, hoses—and into high-tech electronics, navigation, and fuel systems.

Miller fumbled some public statements, making a difficult task even harder. He complained that Delphi couldn’t afford to pay union workers $65 an hour and fund healthcare and other expensive benefits even as the company approved big bonuses for top executives. Hourly workers erupted. Miller faced protests and court challenges. As penance and a PR move, he cut his salary from $1.5 million to just $1. Still, when he looked out his window one day, he saw union protesters carrying signs that said, “Miller Isn’t Worth a Buck.”

But as a result of asking his “bad news” questions, Miller knew the situation was dire. He also knew the crisis extended beyond Delphi. General Motors and other companies depended on Delphi auto parts. If Delphi went under, it could take automakers down with it.

“My goal was to do minimal harm to the world’s auto industry,” he said. “Yes, we had come out of GM, but we sold parts to every automaker on the planet, without which no automaker could do much.”

At tremendous cost to workers and his own public profile, Miller salvaged the company. The concessions he forced and the ripple effect it had through the industry prompted business writer Allan Sloane to give Miller credit for saving “what’s left of the Detroit Three automakers.”

If the problem is eliminated, can we survive?

Miller’s “fearless and clueless” approach to asking about and acting on bad news did not make him popular. But as a surgeon working on a desperately sick patient, he lived by the idea that if you want to fix a serious problem, you have to go looking for it and cannot avert your eyes when you find it. For years after his experience at Delphi, Miller wrote notes to the people whose lives were shattered in the reorganization, explaining and apologizing.

Bad news comes with a price, and whether it’s a business that’s confronting impossible legacy costs or a patient who is in denial about her diabetes, looking for bad news is a necessary first step toward diagnosis and action.

History Is News, Too

News can be bad or it can be good, but history is forever. And history is part of diagnostic questioning. It provides clues and reveals patterns.

When did you first notice this?

How long has it been going on?

What was it like before?

Some of the most effective diagnostic questioners are history buffs. My neighbor, Al Darby, is one of the best. He’s a roofer who specializes in slate roofs, copper gutters, and that tricky flashing that wraps around chimneys and keeps the water where it belongs when it rains: outside. He usually gets called when a homeowner finds water in a bedroom or a hallway, dripping down the wall or puddled on the floor. He starts by asking about the history of the house, the roof, and the water problem.

Does it leak every time it rains?

Does the leak always start when the rain begins?

Where do you see the first signs of the leak and has that changed over time?

Al knows how water behaves. He knows it can travel twelve or fourteen feet across a pipe or beam of wood before dripping into a puddle, so the puddle’s location doesn’t necessarily correspond to where the water came in. He looks for patterns over time. The more he learns, the more specific his questions become. History has made him a detective.

Have you ever repaired the roof?

What exactly have you done?

Does the water drip from the ceiling or down the wall?

Does it only leak when the wind blows?

If the leaks correlate with wind, it could be that something outside has come loose or broken, and the problem might not involve the roof at all. If a repair has been made, he wants to know what materials were used, when, and whether the neighbor’s house is similar and if she’s had any water problems. Only after finding out all he can does Al take a hose to the roof to imitate a rainstorm and duplicate the problem.

Al’s diagnosis frequently surprises the homeowner. Windows are often the culprits; people leave them open or they’re not properly caulked. Clogged gutters are frequent offenders; if water doesn’t drain properly, it can come in through shingles or siding. Wood can rot in the valleys or low points of the roof. Many times, Al has put his finger right through rotten wood that’s let the rain in.

Al asks about a leaky home like a curator asks about a fading manuscript. He knows it is a vulnerable thing, exposed to the elements against the relentless march of time. He wants to know what it’s been through and how it’s been handled. He finds clues in the past.

Al takes immense pride in his questioning. “I love it,” he told me, “because I like helping people solve their problems. It’s as simple as that.”

Challenge the Expert

Gardner, Miller, and Darby are all experts. They put their curiosity and their knowledge to work by asking on-the-money questions that help them identify and treat a problem.

The expert you’re dealing with could be a doctor or a roofer, a high-priced consultant or a friend down the street. But even if they have far more experience than you’ll ever have, be prepared to ask them about their diagnosis. How did they reach it? What is it based on and what is the prognosis? Ask about their process, their experiences in similar situations, and your options, risks, and next steps. Questioning an expert can be daunting and difficult. But often it’s necessary. I know it’s not easy because I’ve been through it, very close to home.

What are you telling me?

What does this mean?

What aren’t you telling me?

My mother hadn’t been feeling well for a while. She hadn’t been happy with her doctor, either. He seemed dismissive of her complaints and suggested her problem was indigestion or just changes that come with age. He didn’t ask whether the sensation corresponded to meals, how it affected her digestion or what was different from how she’d felt in the past. Frustrated and angry, Mom found another doctor who questioned her thoroughly, listened carefully, and ordered tests.

I was on vacation when I spoke to Mom on the phone a couple of weeks later. She sounded fine at first, her usual assertive self. But after a few minutes, she took a breath. Now, don’t worry, she said, but she’d gotten some bad news. The tests were back. She had ovarian cancer.

Before I could even react, she said the doctor was great; he had already scheduled surgery and she’d be going in a few weeks, shortly after I was back. Then there would be chemotherapy. She had confidence in her doctor, she said. Things would be fine.

Life had always been a roller coaster with my mother. She was smart, quick, always sure of herself, profane—there wasn’t a swear word she didn’t use—and the most opinionated person I’ve ever met. It didn’t matter if she was speaking to a teacher or a plumber; she judged everyone and everything. She referred to herself with pride as the “toughest broad on the block.” She bragged about her stubborn independence, which set the tone for just about every conversation she had.

Mom came through the surgery pretty well, though when the nurses came by to get her up and walking, she barked them out of her room. She’d get up when she was good and ready, she said, and she wasn’t ready. This was not going to be easy. The doctor reported that he was pleased with the surgery. He’d removed as much of the cancer as he could. He wasn’t the warmest guy on the planet and could be abrupt. During rounds he was in fast, out fast. But he had a solid reputation as a surgeon and, most important, Mom loved him. She called him “Dr. Blue Eyes.”

But we had questions for the doctor. Lots of them.

What lies ahead?

Which chemo drugs will be most effective?

How will Mom feel?

What side effects should we expect?

What is life going to be like during treatment?

What are her chances of beating this?

Getting answers out of Doctor Blue Eyes was agonizing. He never had much time and he didn’t especially like to talk. When he did, he focused on the clinical parts of the process. We were frustrated. One afternoon shortly after the surgery, I stopped Dr. Blue Eyes in the hallway. Standing a few doors down from Mom’s room, we spoke in low voices. Short questions prompted short answers. I was tired and anxious. I recall the conversation going something like this:

“Where do you think this is headed?”

As he’d said before, the surgery had gone well. Chemo would be next. He’d be monitoring her closely.

“But … what should we expect?”

“Every patient is different,” he said.

“I understand that,” I responded, “but you must have some idea of what this is going to look like.”

“You can’t predict.”

I didn’t want him to predict, just to tell us what Mom was up against and how he felt it would play out, based on his experience and her condition.

I turned the question around.

“Look, if this were your mother, wouldn’t you want to know? Wouldn’t you be asking these same questions?”

The doctor took a breath and considered for a moment. He spoke slowly and deliberately.

“Typically, patients will go through cycles,” he said. “Surgery and the first chemotherapy give her some breathing room.”

“How much?” I asked.

“Usually eighteen months or so. But then the cancer can return.”

“Then what?”

“We try another round of chemotherapy and see how that works. Generally, that knocks the cancer down for another six months or so.

“And?”

“We keep going. We find the drug that works best. Ideally, we manage the disease like other chronic illnesses.” He said that the impact of the chemo often diminishes over time.

“How long can this go on?” I asked.

He hesitated. “The most common is about four years. But there are exceptions. It can go well. Some patients can live very long lives.” We hoped Mom would be one of them.

That little Q&A with Dr. Blue Eyes still plays in my head. I had done some research and I knew generally what we were up against. But I could tell this was going to be even harder than we had anticipated. We needed the doctor’s insight. We wanted to know what he knew. We also wanted to make clear that we were totally engaged and expected to be fully informed. This had to be a partnership and we were entitled to ask.

What’s happening?

How do you know?

Have you seen this before?

What else aren’t you telling us?

Would you say this to your mother?

It can be intimidating to question the expert. But effective advocacy requires tough questioning. Whether it’s your mother or your business, your body or your roof, write out a list of questions and don’t let up until every one of them is addressed. Write out a list of questions and don’t let up until every one of them is addressed. If the specialist you’ve chosen can’t or won’t answer your questions, see that as a red flag, a clear sign that you need to get a second (or third) opinion. Ask more until you’re comfortable that you understand the problem and the pros and cons of each possible solution.

After the Diagnosis, the Strategy

Al Darby, Steve Miller, and Teresa Gardner lead very different lives, but they all use diagnostic inquiry to identify and solve problems. They question with open ears. They ask why the problem exists and where it comes from. They look for bad news. They ask about the past as well as the present. They work under pressure. They listen for detail, and they seek a cure.

That’s how Teresa became well known. She was profiled on 60 Minutes, the longest-running TV magazine show in America, with an audience of more than 10 million television watchers and millions more online. The story showed her driving her beat-up old Winnebago through Appalachia, asking her questions to treat her treasured “human train wrecks.” It revealed the dimension of the problem and her commitment to address it. The attention was more than she bargained for, but speaking invitations and donations followed and Teresa finally got a new Winnebago Health Wagon.

Diagnostic questions identify a problem, a cause, and a response and take you to the next level:

Now what?

What’s the risk associated with the treatment?

What should we be watching for?

Steve Miller thinks CEOs should lie awake at night asking what’s-gone-wrong questions so they can move on to the really big questions.

Are we in the right business?

Are we looking forward?

Do we fully envision the problems and opportunities ahead?

Do we stand for the right values?

Do we have a sustainable business model?

Whether you are a Wall Street tycoon, a nurse practitioner in Appalachia or anything in between, only after you diagnose the situation can you move to the next level of inquiry, where you set your sights and ask about long-range challenges and opportunities in pursuit of an ambitious goal.