It was Sunday. I had one last patient to see. I approached her room in a hurry and stood at the doorway. She was an older woman, sitting at the edge of the bed, struggling to put socks on her swollen feet. I crossed the threshold, spoke quickly to the nurse, scanned her chart noting she was in stable condition. I was almost in the clear.
I leaned on the bedrail looking down at her. She asked if I could help put on her socks. Instead, I launched into a monologue that went something like this: “How are you feeling? Your sugars and blood pressure were high but they’re better today. The nurse mentioned you’re anxious to see your son who’s visiting you today. It’s nice to have family visit from far away. I bet you really look forward to seeing him.”
She stopped me with a stern, authoritative voice. “Sit down, doctor. This is my story, not your story.”
I was surprised and embarrassed. I sat down.
So utterly simple and yet so often forgotten. Read or listen to it all.
Thank you Kendall and elves for this powerful story that brought a tear to my eye. We need to remember again and again the importance of listening. This story reminded me of one I heard some 20 years ago, about an Anglican transitional deacon who was badly injured in a car wreck and left with severe physical disability. It was clear he could never be a priest. Or so it was thought. Several yeares later, in his wheelchair, he was ordained to the priesthood. It turned out that many people took advantage of his listening ear and came to him for confession and counsel. He needed to assure them of Christ’s forgivenness, and in this ministry he was a great servant of the Church.
We are taught in medical to ask open ended questions. We quickly learn to ask closed ended questions. The reality is that financial pressures continue to shrink the interaction time between patients and physicians. Patient perceptions of interaction time are increased by sitting, so I do try to do this.
Unfortunately, patients are notoriously poor historians. We need to do a better job of teaching them to be more efficient. For example, I ask them about a family history of cancer and they launch into how their “wife’s sister had cancer that was all over and she went to Mexico to get apricot seeds then she went on a fruit only diet…” Then you ask about previous surgeries and they respond, “My dad had his prostrate [sic] cut out and he had to wear diapers…”, and they forget to tell you that they, themselves had a splenectomy.
We should be telling patients to write down their symptoms, the chronology of events leading to the office visit, their past medical history including medications (prescription, alternative, and over the counter), any questions they specifically want answered. If they were more efficient, we could relax and be more casual and “shoot the bull” more.
Robroy, I agree that financial pressures are a big part of the problem. It does force doctors to book patients too close together and this doesn’t even allow a patient to be able to give an “accurate history” of their concerns. Most patients feel really rushed when they are trying to explain their concerns to doctors, and this in turn causes them to feel nervous and forget things they would most likely have remembered to say if they were more relaxed.
Yes, having a written history of your symptoms, meds, questions, etc. is especially helpful. I do that myself whenever I need to see my doctor about important concerns. However, more times than not, the doctor still doesn’t “listen” when I read these things to him/her. They more often just rush to their own conclusions and don’t want to even hear your own suspicions of what may be causing the problems. People live in their bodies. They also have previous history of some medical events and know what is going on due to that experience. The doctors in question often don’t want to hear about these previous medical events. They cut you off when you try to tell them about it.
Another pet peeve I have is those “history sheets” the doctors have the nurses give you to fill out when you come into the office. Ever since I came to the USA I haven’t had a single doctor go over that sheet with me EVEN AFTER I’VE TAKEN THE TIME TO BE VERY SPECIFIC ABOUT MY ANSWERS. That sheet would be an excellent guide to direct the conversation and keep the patient focused. However, they just get pushed aside and ignored.
I’m currently experiencing some very scary symptoms and have been seeking diagnosis. I’ve been to ER 3 times and have seen about 5 doctors in their offices; all specialists except for the one who is my primary care physician. I can’t stress strongly enough that these doctors just do not “listen” when I try to talk to them. I’m an R.N. I know my medical terminology, and I keep very good records. In this case I’ve been keeping a journal to track everything in the hopes it will help me sort this out. Whenever I try to share some of my observations in my journal about my symptoms, their frequency, etc., the doctors just turn off and redirect back to their own presumptuous ideas. This has not been helpful. In fact, it’s been very inducive to increasing my stress level. And, yes, like the lady in the article, increased stress does make medical conditions worse.
When I was still practicing my nursing I would make sure to take time to really get to know my patients. I used to love to spend time with them and find out what made them tick. They used to open up when I did that and would reveal all sorts of new information that shed new light on their medical conditions. I felt this was very important. It was a desire to help people and work with them that led me to become a nurse in the first place. It used to frustrate me when nurses were overloaded with case loads too large to enable time to interact in this very necessary way with the patients. They really do need to be heard. They really do need to know that you care. And they DEFINITELY know when you don’t want to hear them or don’t truly care about them.
Another frustration I often dealt with with compartmentalization. People aren’t broken up into several compartments. They are ONE WHOLE PERSON. Their WHOLE body works together as ONE. I’ve so many times approached a specialist who happened to be the primary physician due to a patient being admitted in his DEPARTMENT. I’ve shared concerns told to me by patients that I believed contributed to their “heart condition”, etc. I was most often told literally, “That is not my department” and told to have the patient’s own doctor look into it. That is just plain STUPID and NEGLIGENT! It would be more responsible for the doctor to discuss these concerns with the patient directly and then if another physician (even the patient’s family physician) needs to be consulted, then it’s his/her responsibility to consult with that other physician. It’s not appropriate to pass the buck on to the nurse, or to expect the patient to call the family physician his or herself, which is often the case.
I could write a book about all these cold, impersonal medical actions. The bottom line is that it all goes back the point of this posted article. The doctors need to just LISTEN, and SHUT UP until the patient is done telling THEIR story. You might just be very surprised at how much truly valuable information might come out of THEIR story.
Kendall,
Thanks for posting this online. I caught most of it on the radio when it aired, but am grateful to have the link and be able to read it again.
This is a lesson for us all.
Mugsie, I am sorry about your frustrations. I would find an good (read older) internist. I found this interesting:
[blockquote] Another pet peeve I have is those “history sheets†the doctors have the nurses give you to fill out when you come into the office. Ever since I came to the USA I haven’t had a single doctor go over that sheet with me EVEN AFTER I’VE TAKEN THE TIME TO BE VERY SPECIFIC ABOUT MY ANSWERS. That sheet would be an excellent guide to direct the conversation and keep the patient focused. However, they just get pushed aside and ignored.[/blockquote]
I have implemented questionnaires for my top 20 complaints or so. In this manner, I don’t forget to ask questions pertaining to some of the rare diagnoses. The predominant part of my interview is going over these questionnaires: “You said here that you have headaches on the questionnaire. Where does it hurt?”, etc. After going through the questionnaire with the patient, I have made the (hopefully correct!) diagnosis in probably 90% of patients.
after a ‘middle of the night’ emergency call sent me out -of -state to my mom, i spent a week with her in the hospital/skilled care facility. and i learned (albeit the hard way) that, just like my children, it was what she was ‘not saying’ that was the most important…and often, even those of us who know and love people the best, have a hard time listening to our loved ones’ hearts and souls…and that must be so difficult to try to do during a brief office visit…my prayers are with all of us (clinicians, family members, friends) who care for those we love.
Robroy #5, I’m glad to know you use your questionnaires with your patients. Like I said in my comment above, they can be such a wonderful tool in the office visit. However, every doctor I’ve seen here in southern California so far has not even looked at them. They’ve just shoved them aside.
writingmom15143, #6, you are quite right when you say it’s what they “don’t say” that is the most important. That’s been my observation in my nursing career too. It’s especially common in older, more modest people. They don’t like to talk about certain things, and won’t say anything due to that. Another big area with a lot of people is a lack of trust in strangers. They don’t know you, or that you care about them (as individuals) instead of just another patient, so they won’t confide in you. I’ve learned that if I spend time with my patients (really trying to get to know them) and call them by their names they will build trust in me and then open up more. I’ve had so many things shared with me that many of my co-workers and attending physicians didn’t know due to that. Often their health problems are even caused simply due to stress caused by overwhelming or difficult family members. A lot of patients won’t talk about these things with just anyone. It takes trust to open up like that. Some of the things they have told me are things they just forgot to mention because they felt rushed, and didn’t have time to share everything they needed to. Sometimes it’s been due to feeling nervous and forgetting things. Once a patient is given an opportunity to relax and know they are in a loving environment, they really do say a lot more.
I might be a good idea for those booking the office appointments with the patients to tell the patients to make a list of their concerns before they come. They should write out their symptoms, and anything unusual they feel. They should also be informed to bring all medications in their original bottles, etc. in a ziploc bag. I, personally, don’t always trust lists. There are often errors in those lists and can cause further problems. I prefer to see original bottles from the pharmacy. It would only take about a minute to direct the patient (or caregiver) to do this part before the visit with the doctor, and after a while it would become a more known requirement in general. More people would do it after they’d been told a few times in a loving manner how important this preparation for the office visit really is to the doctor’s ability to help them.