Our Tendency to ‘Medicine Shop’

Melanie: Treating a chief complaint may not solve everything, but it’s the most pressing issue for the patient at that time. How can addressing it be a bad thing?

Grandpa: Instead of theorizing, let me tell you about one of many patients I encountered who were harmed, because a doctor focused only on the chief complaint.

I recall Mrs. Smith, who in her eighties welcomed each day with the exuberant joy of a youngster and bubbled with gratitude for little favors. That was not her demeanor when we first met more than 20 years ago. Though the reason for the consultation was angina pectoris, what truly disabled her was vertigo. When sitting or standing up, or even turning her head, the whole world began to spin and she was overwhelmed by nausea. As a result she was bedridden and unable to play her beloved piano. She was a total invalid and disconsolate for being a burden to her working daughter. For the past five years she had been followed medically by a leading cardiologist in one of the Harvard hospitals in Boston.

Hearing More Than Words: The Magic of Listening

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?