Hearing to Heal

Question: How can I communicate with patients so they feel heard, cared for, and cared about?

I consider this question in response to the woman who addressed our PCM class and who told the story of losing her material goods and livelihood due to a husband’s financial dealings and a precipitating stroke. On that particular afternoon, we were hearing how people deal with acute illness and life crisis issues as this woman described the painful interactions she had with busy doctors who left her feeling distant and unheard.

As I listened, I wondered something to myself. What would happen if patients could write their own notes in their charts about how they feel, what their symptoms are, what they think might be wrong with them, and what we (doctors) should do about it? I began to wonder how much of that note a doctor would actually “hear” and take to heart if it were written in that sacred space and whether they would truly believe their patient’s opinions mattered. The truth is we mostly only allow patients to interact with us on our terms and in our official spaces which doesn’t seem to be a way to place them at ease or engender their trust. To do that I believe we must be partners with them in their care and understand them as they present themselves. While we are trained to approach medical problems from an evidence-based perspective, we can never truly have an “understanding-based” perspective until we include in it the expertise that each patient possesses of their own condition and history.

When I finally enter a practice of my own, I will spend much of my time listening to, encouraging, and negotiating with patients as I come to terms with their worlds and seek cures for their ills. Patients can help me do all of these things. One of the ways the woman described above communicates with her doctor is to write notes in advance of her visits, so she can present a complete list of her concerns when she arrives. Her doctor suggested she do this. Of course they aren’t placed in the chart, but, since she has difficulty remembering her symptoms and collecting her thoughts while she is in the room with him, it effectively allows her to feel that she provides all relevant information to her doctor, and she feels like it is an important part of her being heard - of her story being told. The lesson for me is to be aware of what a patient is capable of and aware of how they will communicate with me. I need to find ways, if they are lacking, of being able to communicate well with patients. It can only give me better information to make a more appropriate diagnosis and allow me to have a sense of where patients are at in order to understand them as “whole” persons.

Here are some additional relevant gleanings that I learned from my favorite family practice physician, Dr. Jeff Stoessl at Salem Clinic in Salem, Oregon:
· Sit down
· Don’t stare at the computer when in the room with a patient
· Don’t look at papers, books, or charts except as a quick reference
· Be 110% focused on the patient - nothing else matters right then
· Look patients in the eye when you both talk and listen
· Politely let them know what you are doing – communicate what is occurring at the time
· Allow patients time and space to think

It sounds obvious, but it comes down to a moment-by moment choice. We must choose to care and listen to every patient. We must choose to act in order to make a difference. We must choose not to be paternalistic or arrogant or the keeper of knowledge. We must convey to patients that we have an interest in their lives and that we care for them as whole human beings. Every encounter is a chance to get better at these things. I can’t wait to try them out.