How are you? A simple question, right? Well, it turns out this question gets more difficult to answer the older one becomes.

Yesteryear, I unwittingly greeted some of my patients with “How are you?” instead of the usual, “How are you feeling today?” I found their responses interesting and decided to do an anodyne social experiment over several months.

The design of the experiment was simple. I would greet everyone with those three simple words (with a smile, of course) and make a mental note of the response. I didn’t write or tabulate anything. Everything was anecdotal.

The responses

Here are some of the noteworthy responses I received:

• “How can you ask me that when I’m here? I’m obviously not ok.” – 42 year old male
• “I’m fine.” – most of the paediatric patients
• “I‘m fine. Thank you. How are you?” – a few of the paediatric patients and less than ten of my adult patients (out of hundreds)
• “I‘m a bit fine” – most adult patients
• “That’s a very stupid question coming from a doctor. I’m obviously not well. That’s why I’m here.” – 23 year old female
• “I’m not fine, but I know I will be after you’re done with me.” – 74 year old female

In summary, I noticed that the younger the patient, the more positive the response. In other words, younger patients treated the phrase “How are you?” as merely a salutation, adults handled it literally, as an enquiry. You would assume the opposite, right? Children tend to have more concrete thinking than adults in everything else so why this disparity?

After reviewing many patients, I realised that their response to “How are you?” was commensurate to the trajectory of their healing process. To help me better understand this relationship, I turned to the Sick Role Theory.

The Sick Role Theory

In 1951, the American Sociologist, Talcott Parsons made a seminal contribution to Medical Sociology when he described the four aspects of the sick role, viz:

1. immunity from normal social role responsibilities such as chores and other work
2. the prerogative of not being held responsible for being sick
3. the inclination to get better and
4. the commitment to find a proper remedy and submit to that advice

The first two are classified as “rights” and the last two are termed “responsibilities” or “obligations”.

Over a decade later (in 1965 to be exact), another American Sociologist, Edward Suchman published the five stages of the sick role, viz:

1. symptom experience
2. assumption of the sick role
3. medical care contact
4. dependent patient role and
5. recovery and rehabilitation.

As I was stewing over the findings of my “kindergarten research”, I realised that older patients replied in a literal manner to “How are you?” in the fashion that they do because they unconsciously assume the sick role immediately after they enter a health institution. According to them, the normal social expectations of obeisance towards strangers do not apply to them simply because they are sick.

On the other hand, younger patients have not yet been conditioned to assume the Sick Role in its entirety immediately. In other words, they do not yet know that it is socially permissible, according to Parsons at least, to be mean to healthcare staff when they are sick.

After I concluded my scrutiny, I appreciated that something as benign as a response to “How are you?” determines how far and fast one will go on their healing journey.

The Healing Process

I will never, in my lifetime and the one to come, overemphasize the role of faith in the healing process. It is a simple fact. If you believe you are sick (and will continue being ill) indeed, you will feel sick (and continue feeling sick). On the other hand, if you believe that you are temporarily unwell (but will get better soon), you will heal quickly. Again, I emphasize, that it is that simple.

To put it in another way, if you take possession of your “rights” as a sick individual, without concomitantly practising your “responsibilities” (aspects 3 and 4 of the sick role, i.e. not having faith that your healthcare provider will help you feel better), then your healing process will be arduous.

How, then are we to reply when a healthcare worker asks us, “How are you?” Just say, “I’m fine, just a bit unwell today.” That is when the healing process starts. It begins with the expectation and conviction that you will recover.

Remember, even if you are sick, your normal state is good health. Going back to your baseline starts by defining and proclaiming it. Words are powerful! Be careful how you use them.