The art of listening to patients …with patienceJuly 11, 2020
Modern technological advancements have improved the outcome of medical treatment for many diseases. Yet, in daily life, patients continue to be dissatisfied with their encounters with the healthcare system, leading to doctor-shopping and litigation.
The average doctor works against the barriers of a shortage of time and a crowded schedule. This makes it difficult to listen to what the patient is really saying, or in other words, “to hear between the lines”. Why do we need to listen to our patients? The patient comes with an “illness”, and the doctor wishes to identify the “disease”. Having ticked off the disease box, he is ready to proceed with the logical therapy. The problem arises when the patient’s illness does not fit with any known disease, or his fears and anxieties continue to hamper well-being.
Good listening skills foster the formation of a therapeutic relationship which acknowledges respect for, and a willingness to be interested in, the patients’ unique context.
The talkative patient can take up valuable time. Rather than cut short the conversation abruptly, allow the patient to tell the complaints without interruption, till it is clear where the narrative is leading. Then, the doctor can politely sum up the main symptoms, validate them, and redirect with relevant questions.
Another problem arises when enthusiastic family members take over the task of describing the problem, leaving the patient silent. Without causing offence, asking for the patient’s side of the story enhances patient satisfaction.
The shy patient needs to be reassured of confidentiality and this expression of empathy gives the patient confidence and reassurance.
Some patients state a problem which may not be the real issue. This is usually due to the conversion of anxiety or grief into a bodily complaint, known as somatisation disorder. A young newlywed girl came with a severe headache. It was clear that she had a migraine, and she insisted on a CT Scan. After discussion, it became apparent that she was under pressure to get pregnant.
The lesson one learns from these stories is to develop an “antenna” to look for abnormal reactions to common problems.
Depression and anxiety are common problems in general medical practice but often missed. Empathetic communication can elicit clear features of depression. The “ICE” technique is useful. Ask the patient to give his own ideas, concerns and expectations of his complaints to bring out the real problems causing the symptoms. The bio-psycho-social concept of illness is a well-established model of understanding the reasons why people seek medical help. Active listening is an important way to unravel the complex presentations of illness.
—Author is Consultant Geriatrician, GKNM Hospital, Coimbatore, and former HOD, Dept of Internal Medicine at CMC, Vellore. The author can be contacted at: firstname.lastname@example.org