Earlier this week I had the privilege of hearing Drs. Leana Wen and Joshua Kosowsky—the authors of When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests—speak. It was moving to see two MDs pounding the pavement with an urgent appeal to patients: speak up! Your voice is critical to the diagnosis process.
Here were my big take-aways:
1. We need all voices to see the big picture, and patient’s choices to use their voice make a big difference. When something feels off or painful, it is tough to describe and find what’s actually going on. In the work of translating felt knowledge into words, we need everyone’s voice. And there’s a lot at play influencing patients’ choices to use their voices (or not). Wen and Kosowsky address the work of being a patient; they offer tools for patients to enter real partnerships with doctors. And they show that there are very real barriers restricting this kind of communication. These barriers exist on both the side of the patient/family, and the side of the providers. Sure, everyone’s on board with the idea of patient-doctor partnerships in theory–teamwork is the word on the street–but in reality, there’s a lot in the way to consider. It takes confidence for doctors to acknowledge their need for voices of others, like nurses, social workers, other doctors, physical therapists, patients. Props to them for reaching out.
2. We need to re-examine what “satisfaction” means. Too often it’s interpreted to mean ordering tests. Too often patients end up feeling overtested and unseen (and unheard) as a result of their experience. What if doctors could develop confidence in the data gleaned from attuning to patients by listening and looking? The results would be improved diagnoses, improved patient satisfaction, and reduced costs.
3. “Commonsense” = efficiency. It’s not a throwback to old ways of doing things. Wen and Kosowsky call listening an aspect of “commonsense” medicine. I like that term a lot because, as neuroscience indicates, listening becomes anyone’s capability with the choice to connect attention to senses. It is sad to me when the human capabilities associated with accurate diagnoses (like listening and observation) are wrongly viewed as a throwback to old ways of doing things. It is only with these creative skills that we can navigate the information age and utilize technology efficiently. Wen and Kosowsky mentioned that a commonly cited excuse for not listening well is not having enough time. Because they are both practice Emergency Medicine, where there is zero time to waste, it was particularly helpful to hear from them that listening is not only essential to reaching accurate diagnoses, it’s actually efficient. They say it takes less time than is commonly imagined. It is time to reclaim resources we already have and break down siloes that no longer helpful or true. Commonsense need not be counter culture.
4. Voice practice starts now. This talk validated my own experiences as a patient and inspired me to consider them as part of my work in healthcare. I felt newly grateful for the times as a patient I’ve had the benefit of being able to be proactive. For example, once an orthopedic surgeon couldn’t help with the mysterious pain and swelling in my ankle. He told me I just “shouldn’t run.” I got angry. I was not articulate (although the emotional rash on my chest and cascade of teary snot probably spoke volumes). I did, however, get myself a second opinion, which led me to physical therapy. Two marathons later not only am I still running, but I know how to care for my ankle and its wiley ways. What a difference between “you can’t be helped” and “I can’t help you, but look to another approach.” I tend to take for granted the resources it took for me to get a second opinion. There were many – and they might not be there in a different kind of scenario. It’s precarious business and things change quickly; whoever we are, this is our system for managing health. As healthcare faces dramatic changes—perhaps towards an age where, as Eric Topol predicts “patients will largely manage their own care”—we all need all the advocacy tools we can get. Wen and Kosowsky say start practicing now.
Because I join Wen and Kosowsky in the enterprise of helping trainees learn to attune to patients, I would have liked to have heard more of their opinions on the education piece: how do doctors learn to listen? What does it take? And what is real listening all about? In my opinion, this is the work of quality attention and attunement – how people learn to gather and synthesize data from the world and identify the needs of others. Attunement is important in all fields, but especially critical in healthcare; care can’t be provided without knowing what the problem is in the first place. And when care is provided for an inaccurately described problem, medicine risks failing on its first promise, to “do no harm.”
I look forward to checking out the book!
2 Responses to ““Commonsense” But Counter Culture”
To my chagrin, as I went through my medical training and then as I was a trainer of new medical students and saw how they were being trained, it became apparent that a lot of what we were doing was not focused so much on diagnosis, but focused on these pathways to rule out particular syndromes or diagnoses or to work up certain syndromes or diagnoses and leaving patients often as confused and as frustrated as when they walked in.
It is this era of medicine to which many doctors and patients now look with nostalgia. Older doctors frequently bemoan the fading emphasis on the art of medicine, and those who practiced in the waning days of the Golden Age speak of the time spent listening to their patients, of developing an intimate familiarity not only with their patients’ individual histories, but also with how the disease affects each particular patient. When they went to their G.P., patients were confident that someone who cared about them was listening to their story and doing his best to diagnose and to heal.