Health Column: The listener, does your physician fill the role?
MOHLER’S MEDICATION MAXIMS
Free Press Health Columnist
In 1960, my wife-to-be gave me a book that has had a profound effect on my caring for patients. “The Listener,” Taylor Caldwell’s novel, tells the story of John Godfrey, a retired lawyer in a large Midwestern city, who erects a beautiful marble sanctum as a monument to his late wife. Inside, behind a screen that hides him from each visitor, is the unknown one who sits and … listens. Each of the 15 chapters chronicles the story of a troubled person being listened to and how simply being heard is healing.
“Can you hear me now?”
When doctor/patient relationships unravel, the most common feedback from the patient is: “He (the physician) didn’t listen to me. He didn’t understand what was going on with me.”
WHY DON’T PHYSICIANS LISTEN?
Some physicians plead that there is not enough time to listen well. The economic demands of modern practice create a culture of seeing more patients faster. Sometimes technology replaces carefully listening to the patient’s story. Ordering a CAT scan of your belly has become the standard of care in trying to diagnose your appendicitis. Finally, medical training too often focuses on the science of medicine, and less so on the fine art of listening to the patient’s story.
The sequelae of your doctor not listening well may be significant. An incomplete history, the failure to take the time to consider alternative diagnoses and prematurely closing the visit are thought to contribute to over 25 percent of all medical errors.
What can you do, faithful reader, to make yourself heard? Be assertive!
Your window of opportunity to tell your story is a tiny porthole of a bathroom window. Recall the study that showed that physicians, on average, interrupted their patients 18 seconds into their stories.
1) You need to walk into the office with written notes of the chronology of your story. Take a discrete notebook or a Big Chief tablet. The latter advises your doc that you are on a mission. Concisely describe the symptoms you have experienced in simple, non-medical terms. Avoid chiming in with your diagnosis or that of your neighbor who is certain you have Chronic Fatigue Syndrome. Self diagnoses often derail the visit.
2) Take someone with you to coach you if you get off script and help you recall the essential elements of the plan afterward.
3) Prioritize your questions. You may never get to question number three.
4) At this point, if your physician seems distracted or unengaged, ask him or her: “At this point, what are you thinking?” If your physician is not tuned in to your story, re-orient the discussion.
One of the wondrous experiences of being a family physician is finishing an encounter with a patient where no diagnosis was made, no test was ordered, no advice was given and the patient turns to you and says: “I feel so much better. Thanks for listening.”
Free Press health columnist Dr. Mohler has practiced family medicine in Grand Junction for 39 years. He has a particular interest in pharmaceutical education. Phil works part-time for Rocky Mountain Health Plans. Email him at firstname.lastname@example.org.
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