Melanie: Okay, we agree that doctors and patients need more quality time together, but you haven’t explained ‘how’ that’s possible.
Bernard: Time doesn’t have to be everlasting for a doctor to be responsive to a patient. It can be stretched through a host of measures—for example, by facing the patient at eye level, by not interrupting a patient’s narrative, and by observing non-verbal cues. These straightforward measures intensify time without extending it.
Melanie: What do you mean by non-verbal cues?
Bernard: Listening doesn’t just merely refer to verbal input. We each possess a powerful nonverbal repertoire based on body language and facial expressions. This may involve a tiny narrowing of gaze, a stare or diversion of eyes, a shrug of the shoulders, a tightening or unfolding of hands, a shuffling of feet, or uncrossing of limbs. Why is a patient looking away or visibly fidgeting? Is she hiding something? What’s going on?
Melanie: Didn’t you once tell me about how a woman looking at the ceiling saved her husband’s life? What was that all about?
Bernard: Many years ago I began to encourage husbands to make sure that their wives accompanied them on medical appointments. At times I was very insistent that the wife come along, and I even indicated that a return visit would be postponed if the wife could not be present.
I must confess that at the time I began my practice, I didn’t fully understand the basis for my insistence that wives be present. I did know however, that nothing is more complex than an individual human being, and to deal with complexity requires multiple perspectives. Numerous times I have been forced to reformulate a rendered prognosis, change a diagnosis, or alter prescribed medications based on a partner’s shrewd comments or nonverbal cues.
Once, a Chinese patient I had followed for nearly ten years did not let on that his condition had strikingly deteriorated. Worse still, he lied to me about what was transpiring. He desperately feared heart surgery. Fortunately, his wife was present. In past visits she looked at me unwaveringly, though never uttered a word. This time her eyes were riveted on the ceiling. Troubled by her changed behavior, I urged her to tell me what was going on.
Initially she refused, insisting, “A Chinese wife is not supposed to talk behind her husband’s back.” After some pressuring, she related that her husband had been forced to stop exercising and retire from his job because of the frequency and severity of angina pectoris.
An immediate workup revealed that he was verging on a cardiac arrest. He had a heart operation that very day and made an uneventful speedy recovery. Had his wife not accompanied him, and had I not “listened” with my eyes—I would have missed this profound change in his status. He probably would not have survived such an error.
Copyright © 2012 The Lown Conversation
The Lown Conversation 