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The One Question Doctors Should Be Asking—but Never Do

Beyond the measurable health indicators, doctors need to ask questions that are focused on well-being, says WSJ Health Expert Marc Agronin. During a routine visit with your doctor, you anticipate questions about your diet, weight, smoking and drinking. But there’s one important health-related question that our doctors never ask, but should. The words of this question are simple but the implications of the answer profound: “What’s your sense of purpose in life?” I’m not suggesting that your doctor needs to become your personal philosopher or theologian. But consider this fact: Doctors are obligated to conduct several routine tests and give you the standard admonitions about diet, exercise and smoking because research clearly shows that individuals who smoke, are obese or have diabetes may lose, on average, five to ten years from their life expectancies. And yet, our doctors should consider adding to this approach the fact that key scientific findings indicate having a sense of purpose can equal or even outweigh these common factors. For example, several recent studies have shown that as we age beyond midlife, purpose is associated with a reduced risk of physical disability—in one study even more than physical exercise. Similar research has shown that having a positive attitude toward aging—a key component of purpose—is associated with an increase in lifespan of up to seven years. How might this work? It has been proposed that a sense of purpose can improve our body’s stress response, foster healthier behaviors, and affect physiologic risk factors for cardiovascular disease. The result is fewer strokes and heart attacks and less physical disability. But more than that, we simply feel better when we have purpose. How might doctors actually ask the question of purpose in ways that lend themselves to a practical, productive discussion? A good guide can be found in psychologist Carol Ryff’s Scales of Psychological Well-Being, which includes a rating for purpose among its six key indicators, along with autonomy, environmental mastery, personal growth, positive relations with others, and self-acceptance. In this inventory, purpose is measured by the degree to which we have goals in life and feel that there is meaning to our past and present circumstances. This sense of purpose may be reflected in daily work or caregiving, relationships, core religious or philosophical beliefs, and an assessment of what we’ve accomplished in life and what we want our legacy to be. Although these factors appear to be deep, existential issues that most doctors hesitate to ask about (and are certainly not trained to investigate), they can actually be assessed quite simply. Imagine your doctor asking you these three questions: What activities, pursuits and relationships give you the most pleasure and meaning? What are your reasons for living? What do you want to accomplish or experience in the coming years? Our answers indicate the degree of purpose we have in life, which can be translated into potential health benefits. In addition, the very act of being asked these questions can create a unique bond between ourselves and our health-care providers, teaching them not only about our aches and pains, but about our strengths and dreams as well. If you are so fortunate as to be asked about your sense of purpose but find yourself searching for answers, take it as an opportunity to improve upon your mind just as you might improve your body through diet and exercise. There are myriad possibilities—volunteering, caregiving, grandparenting, craft-making, traveling, praying, creating…it’s an endless list. The need for your purposeful efforts is great, and they’re good for your health. Your doctor, one day, may say so, too.


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