Blog | Thursday, July 3, 2014

The things we learn from listening to patients


It is one of the first things we learn in medical school, repeated to us over and over again by our clinical teachers: Listen to your patient. Yet in everyday medicine, this seemingly simple thing to do often proves elusive.

In fact, it is typically one of patients’ most common complaints when they are surveyed, “The doctor didn’t listen to me.” This perception holds true for both primary care and the hospital environment. Another frequently cited statistic states that on average, the doctor only allows the patient to speak for several seconds before interrupting them, with studies showing it’s usually anything from 12 to 23 seconds.

My own personal experiences and those of observing probably hundreds of colleagues is that no doctor sets out with the intention of not listening to patients. Physicians, and health care professionals in general, are probably the most patient people out there. In defense of doctors, sometimes we need to steer patients towards the right path if their answers to questions become somewhat tangential, and this can sometimes be interpreted as not listening.

In the busy world of medicine, the time that doctors have is very limited. A close friend, who is not in health care, once remarked to me how all the doctors he’s ever met “always seem really rushed.” That was in England, and no doubt is the case all over the world. The art of listening to patients fully, while also being efficient, is a difficult one to master. When we do spend more time listening, here are 3 very important things we can learn from our patients in the hospital environment:

What is bothering our patients at a certain time is frequently not their presenting complaint. While of course we have to focus on the main problem that has brought them into hospital, we must also address whatever else is concerning them at that particular point in time. In my experience, it is most often a completely different issue that has come up while they are in hospital. Whether it’s a side effect of a new medication, or wanting to change their room because of a noisy neighbor (a very common request!), we must remember to at least devote some time to listening and imagining ourselves in their position. Whatever we can do to help, should be done, especially because most of these issues don’t take very much time at all to address. If the primary function of a doctor is to be a healer, a sympathetic ear goes a long way.

The impact of psychosocial factors on any patient’s illness is only half the story to understand the current illness, without taking into account what else may be happening in their lives. For instance, has a stressful life situation pushed somebody over the edge and contributed to their hospitalization? Does a lack of social support result in them not wanting to leave the hospital? Never underestimate how much of medicine is all about peoples’ social circumstances and personal life situation. As Hippocrates himself once said; “It is more important to know what sort of person has a disease than to know what sort of disease a person has.” It was the case over two millennia ago, and still is today.

Patients usually know exactly what’s wrong with them. This may sound a bit odd, because patients come to doctors for a diagnosis. However, when the doctor is stumped about the source of a medical problem, the patients themselves will often know the answer. From distinguishing between a chronic bronchitis flare-up and congestive heart failure, to knowing whether their condition is an infectious versus a non-infectious etiology—patients are almost always their own best doctors. I never cease to be amazed by the accuracy of the answers when I ask my patients, “what do you think is wrong with you?” They are typically spot on!

These are just 3 things we can gauge by spending a little more time talking to our patients. As doctors go about their hectic days, it’s so important to take the time to do this and ensure that we’ve listened as much as we can and also answered all their questions. For us, it may be another day at work. For our patients, it is a frightening and low point in their lives. Nowhere than when doctors interact with patients does the old saying hold more true: “If speaking is silver, then listening is gold.”

Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.