“Oh doctor, one more thing . . .”

Melanie:  I want to thank Carolyn Thomas, a heart health advocate and creative dynamo behind the blog Heart Sisters, for providing inspiration for this post. In a recent comment on our blog, Carolyn wrote, “I suspect that this misplaced focus on the ‘chief complaint’ is also a major source of frustration for doctors when the patient waits until the doc’s hand reaches for the doorknob to leave at the end of a visit before asking: “Oh, Doctor, one more thing . . .”

Grandpa, I think Carolyn raises a great point! We’ve talked about the consequences for patients when doctors don’t listen, but what happens when patients don’t readily share, or only hint at critical info in passing at the end of a visit?

Grandpa: It means something unfulfilled, and one of many cues doctors need to be sensitive to. But no cue is meaningful unless the doctor is familiar with the patient.  Sensitivity to an unspoken word is magnified with intimacy, not alone with ‘the patient’ but with the human being who resides inside the patient.

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?

What Patients Really Want

Melanie: Grandpa, what you’re saying about listening makes sense in theory, but you may not be aware of the dizzying pace of our modern age. In your day, it was easier to have an actual relationship with patients. Times have changed and freeing up an afternoon for the equivalent of an old-fashioned ‘house call’ isn’t always realistic for doctors or patients. And maybe something happened on the way to the clinic; maybe today’s patients don’t actually want relationships with their doctors. Sometimes, we seek expertise simply to make sense of the information we find online, ease our anxiety, and determine the right meds so we can get on with our day.

Bernard: It may indeed be a “dizzying pace,” but being upset about the doctor spending too much time with a patient? You are joking. Have you ever heard anyone complain of that?  On the contrary, people are upset with doctors for short shrifting time with them; for not listening to what is troubling them, for interrupting them after a few sentences, for looking at the computer screen rather than at them, for responding to telephone calls and pages while they are trying to rivet the doctor’s attention. In short, people crave trust and caring.

Science, Technology and What Really Heals Patients

We’re trying a new conversational format. Let us know what you think!

Melanie: Grandpa, you spent the  last two posts praising the art of listening to patients. You have said, “The more time you spend with the patient, the less harm you do to the patient . . . When doctors do not spend enough time listening, they become triage officers for specialists, as the patient is reduced to an assemblage of dysfunctional parts each part being served by some expert.” Who would disagree?

Although listening is a vital skill for a doctor, and certainly “rewarding and therapeutic for both doctor and patient”— I’m confused. You are a man of science! You developed the defibrillator and the cardioverter; you introduced the drug lidocaine to control heartbeat disturbances; and you paved the way for the modern coronary care unit. How can someone like you condemn the use of medical technology?

Doctors Don’t Listen

My grandfather (always) has a lot to say! Here is more from him on the topic of ‘listening’…  -Melanie

Our fine art of listening must have evolved over hundreds of millennia of evolutionary experimentation. Listening probably preceded and shaped speech. Much of our body participates as we listen and respond. This ranges from a shrug of shoulders, a crossing of legs, a furrowing of brow, or shifting of gaze. Having traveled widely, I marvel at our common humanity affirmed by our shared body language.

Listening has been central to doctoring. Together with the physical examination it cements relationships and facilitates reaching a rapid and relatively accurate diagnosis. These interactions with patients are now being frayed or even totally abandoned. In fact several studies indicate that during an initial visit doctors interrupt patients after only 18-seconds. A physical examination, if performed at all, is limited to the body part a patient initially complained about. Leached out from the medical encounter is the patient as a human being.