You’re Not Listening To Me.

Medical diagnosis and its evil twin, misdiagnosis, are profoundly influenced by the physician’s ability to effectively listen to the patient.  There are great diagnosticians and some doctors who are not so great diagnosticians.  The great ones almost always say the same thing, “If you listen to the patient, she will tell you all you need to know.”

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There are many trends in medicine which discourage physicians from listening to their patients.  Probably the most important of these is the press of time.  Doctors are being pushed by economics to spend less time on each patient visit.  The less time there is for a visit, the less time the doctor has to listen to the patient.  Maximizing the number of patients a doctor sees in a day may be a good way to maximize income but it is a terrible way to deliver good medical care.

Many doctors have personality traits that make it difficult for them to be good listeners.  Tops on that list is a lack of patience.  They want to cut to the chase.  They interrupt the patient when the patient is trying to tell them what is wrong.  They ask questions early, which tends to cause them to form a diagnosis before they have heard all the facts.  Once a diagnosis has entered the physician’s brain, his or her hearing becomes selective and they tend to hear those things that support the diagnosis and discard those that don’t.  They don’t value the patient and the patient’s perception of what is wrong.  After all, who went to medical school?

Patients play a role in poor communication as well.  One article I read advanced the position that patients sometimes act like hostages.  They are reluctant to speak.  They are reluctant to contradict or to challenge the physician/captor.  They feel powerless and dependent on the physician.

Failure to listen results in dissatisfied patients who conclude that the doctor does not have the time for them, that the doctor does not care about them as persons but only as patients, and that their fears and concerns are valueless.  The trust that is such an important part of a good physician/patient relationship is hard to create when there is a failure to listen.  Failure to listen also increases the chances for a miscommunication.  Doctors need to hear all that their patients have to say.

To its credit, the medical profession recognizes the problem with listening to patients and has tried to change its ways.  Article after article in professional journals or presentations at seminars urge doctors to engage in active listening.  An active listener doesn’t just listen, she engages with the patient.  She is in the moment and giving the patient all of her attention.  No multitasking.  No writing or typing on the computer while the patient is speaking.  She does not interrupt.  She interprets what she has heard and repeats it back to the patient.  She watches the body language of the patient and avoids body language on her part that might suggest disinterest or being closed to communication.  These are the keys to good communication.

As a patient, don’t be a hostage.  Insist that the doctor listen to you.  If the doctor is impatient or for any other reason, won’t listen to you, find another doctor.  You owe that to yourself.


Posted in Doctors, Fee for Service, medical charts, medical errors, medical ethics, medical mistakes, Medical Negligence, Misdiagnosis |