The Courage to Question: How Why Drives Progress

My 9-year-old son is a seeker. He absorbs information and ideas faster than SpongeBob SquarePants cooks Krabby Patties. Every answer sparks more questions. It challenges me when he asks questions. Sometimes I know the answers, sometimes I don’t. Sometimes I can articulate the concept he’s seeking; other times I can’t. It’s not easy answering the questions of an earnest, honest child. It requires self-knowledge, humility, perception, wisdom, and patience. I don’t always have those things, let alone all at the same time. It helps to remember that his seeking drives his questioning to understand the world and why we’re doing what we’re doing.

Image Credit: MedicalWorks | stock.adobe.com

The process of questioning forces us to continuously reframe what we are asking, peeling away layers of an intellectual onion to arrive at the truth. But to arrive at the correct conclusions, we must ask the right questions. If we condense the novel The Hitchhiker’s Guide to the Galaxy, we’re left with this idea: The answer is easy once you can properly formulate the question.¹ And the ultimate question takes but one word: Why?

My time in health care has been guided by why. My own seeking in my work helps me to understand my son. It helps me to understand my approach to the world, the outcomes of my questioning (not always positive), and the importance of continuing to question. To illustrate this, let’s try a hypothetical discussion prompted by scenes in health systems across the country: Wow, today was challenging—so much to do, so few people to do it right. But we’re not expanding staff. Why? Patient volumes are higher than ever. Oh, I see. Productivity metrics don’t support the requisition process justifications for more staff. Why? How do we know we are using the correct metric and not just the easily quantifiable ones?² Oh, those metrics are determined by corporate leadership. Well, how do we know that approach applies to our times? Why aren’t our metrics driven by impact instead of measuring widget production? Oh, we don’t have those metrics yet. Why not? Oh, corporate hasn’t authorized them? Well, why does a corporate entity govern our clinical practice? Are we a corporation then? Ah, so we’re not a corporation; we’re a nonprofit institution. I see, but why can’t nonprofit entities become corporatized as they scale? What does corporatization even mean in health care? How do we define it?³ And so on ad infinitum. You can see how following why leads to more questions—questions that require confrontation with the current state of health care affairs. Confronting the information dodges the obscurity of hard answers to hard questions.

These themes and approaches color my writing, teaching, and precepting. Wielding why, seeking truth, and applying unflinching honesty resonates with learners in a disposable, plastic world. The authenticity of critical thinking carries its own allure, for these ideas are a psychic panacea. Frank Herbert christened them the “attitude of the knife—chopping off what’s incomplete.”⁴ Knives remove what isn’t necessary from what is necessary. So we use why as our mental razor. Children come equipped with a built-in “crap detector,” which Ernest Hemingway claimed was necessary to be a great writer. Such a detector is a crucial survival strategy in today’s health care world. And how does one cultivate a crap detector, you might ask? Hint: See above. It’s asking why.

In 1969, social thinkers and education critics Neil Postman and Charles Weingartner advocated for radical education reform where active participation, critical thinking, and questioning established norms were central to propagating people’s crap detectors.⁵ In their view, educators should be challenging learners to question, explore, and build their knowledge instead of passively assimilating others’ ideas. Fast-forward 56 years, and you have me asking why these principles can’t be applied to pharmacy practice. Why can’t a generation of pharmacists with crap detectors use those detectors to save pharmacy? My coal mining ancestors relied upon canaries as an early-warning system for the buildup of toxic gases (such as carbon monoxide) in mines. This is because canaries’ rapid breathing rate and respiratory system make them exquisitely more sensitive than humans to airborne toxins: If the canary showed signs of distress, miners knew something was wrong. Perhaps oncology pharmacists are the canaries of health care systems. Perhaps our exodus from the profession is a sign that current practice models and environments are toxic and unsustainable.

Oncology pharmacists must take the lead in rehabilitating oncology pharmacy practice. As the canaries in the coal mine, we should stress values that are not stressed by other major institutions in the culture, to paraphrase Postman and Weingartner.5 The hospital and health system begets its own answers due to the environment it fosters, so we need to approach problems from outside that environment. We need to be part of our own culture but, at the same time, be out of it—or in other words, be able to see things as they are and think critically about how to correct them. Asking why can help us get started, and so can incorporating ideas from fields unrelated to oncology pharmacy and health care provide a fresh perspective. Colonel John Boyd described this idea in his briefing “Destruction and Creation,” which evolved into the following illustration⁶:

1. Start by breaking down a snowmobile into its various pieces by imagining 4 unrelated things:

a. A skier b. A speedboat c. A bicycle d. A toy tank

2. Then mentally deconstruct each thing into its components:

a. Skier: skis, chairlifts, mountains b. Speedboat: outboard motor, boat, water c. Bicycle: handlebars, wheels, chain d. Toy tank: treads, turret, cannon

Very well, you might be saying. You are just breaking a snowmobile down into its first principles. True, but stay with me. The magic is just about to happen. If we use a process of destructive deduction and break apart the assumed relationships between each item and its components, we can create something new: something that wouldn’t have existed by only thinking in the original frameworks (this is where we are in health care right now).

Let’s take one part from each idea and component above:

• Skis (from the skier)

• Outboard motor (from the speedboat)

• Handlebars (from the bicycle)

• Tank treads (from the toy tank)

By recombining these pieces, we can create something that did not exist before: a snowmobile. Our new reality in oncology pharmacy needs to be built on creativity and adaptability. The creativity and adaptability we seek arise from the capacity to deconstruct existing concepts (eg, oncology pharmacy practice models, health care systems, etc) and synthesize new ones from the resulting disparate elements. There is no problem-solving without first having destruction and analysis, and no creation of new ideas without synthesis.

I challenge you, dear reader, to follow these steps. Use your unique perspective to deconstruct your current practice model and health system and analyze your findings. Ask why often along the way. Then recombine it into something original that only you could have come up with, incorporating your life experiences, trials and tribulations, and joys and sorrows. Send what you create to me, and we’ll combine ideas for remodeling oncology pharmacy practice in a future column. None of us is as important as all of us. This won’t be an overnight change, for pressure and heat don’t equal success in the instant pot of pharmacy practice. There are no shortcuts: Time is still needed.

That’s how we will avoid riding off into the slow decay of a system that cannot last and is ripe for reconstruction. That’s how we will spark the torch to light our way. I leave you with 2 parting thoughts for guidance:

Questions are the answers you might need.

—Oasis

I wish you no luck but only simply want you to be what you are.

—Cid Corman⁷

REFERENCES

1. Adams D. The Hitchhiker’s Guide to the Galaxy. Del Rey; 1997.

2. Mahmoudjafari Z. Measuring impact without adding burden: finding meaning in the metrics. Pharmacy Practice in Focus: Oncology. April 11, 2025. Accessed July 15, 2025. https://www.pharmacytimes.com/view/measuring-impact-without-adding-burden-finding-meaning-in-metrics

3. Fuse Brown EC. Defining health care “corporatization.” N Engl J Med.2025;393(1):1-3. doi:10.1056/NEJMp2415485

4. Herbert F. Dune. Chilton Books; 1965.

5. Postman N, Weingartner C. Teaching as a Subversive Activity. Delacorte Press; 1969.

6. Boyd JR. Destruction and Creation. September 3, 1976. Accessed July 15, 2025. https://www.coljohnboyd.com/static/documents/1976-09-03__Boyd_John_R__Destruction_and_Creation.pdf

7. Massey J. Things worth remembering: ‘Be what you are.’ The Free Press. May 4, 2025. Accessed July 15, 2025. https://www.thefp.com/p/things-worth-remembering-be-what-you-are