patient-doctor relationship

Doctors Learning to Listen Better

In medical school, we learn the art of questioning and we are taught that the diagnosis is usually revealed in the history. Students memorize a barrage of hundreds of questions to help them narrow the wide differential diagnosis that they are working out in their heads while they talk . . . and listen.

When I teach medical students and residents in my clinic, I first demonstrate a crucial but oft neglected aspect of taking a proper history. After our patient leaves, I ask them if they noticed what I did.

Sometimes they don’t. It’s that subtle yet it can make a difference.

After greeting patients by name with a handshake (after which I clean my hands with Isagel – we practice that to an art as well), I’ll ask how they have been and what brought them to the clinic (Most of the time, they don’t say the taxi, bus or partner). At this time, I’ll let them talk uninterrupted for at least 2 minutes.

This may seem counterintuitive in a busy medical office especially if we’re running behind schedule. However, this practice can save time, enhance communication and help me make the right diagnosis.

When we plan to see a physician for a medical problem, we will formulate in our minds how that problem presented. It can be quite a detailed story that we rehearse in our minds while we are waiting for the appointment and in the minutes before we actually see the doctor.

When patient-physician interactions were observed, it was found that most physicians interrupted their patients within 2 minutes.

If I interrupt patients before they finish a few sentences, I would have derailed the telling of their story. Crucial details may be missed that may or may not be picked up in the typical medical interrogation, and without enough information, we are more likely to miss the correct diagnosis.

After my patients explain their symptoms in their own way, I’ll ask for those further details we learned so well in medical school.

Of course, not every problem or all patients need as much time to tell their story, but it’s important for the well-being of the patient and the health of the patient-doctor relationship to give that time and to take the time to listen.

By Davidicus Wong

I am a family physician. I write a weekly newspaper column, Healthwise for the Vancouver Courier, Burnaby Now, Royal City Record and Richmond News.

12 replies on “Doctors Learning to Listen Better”

🙂 !! Yes, the doctor’s I would refer people to and I do have them lol ! they took the time to listen whether it was about myself or my daughter, they listened. NICE!

When I have to find a new GP (for reasons beyond my control), in the initial interview, I ask them to consider that I am the first responsible for my own health and, as a consequence, I want to know everything the Dr finds. If they can accept that, I am happy. I now have a wonderful Dr who listens, explains, can take a joke, knows the right specialists, and is young enough not to retire on me. One thing I cannot stand and have have been up against, when in the ER, for example, is doctors or staff calling me “Dear” or something equivalent. I know I could be their grandmother, but it makes my blood boil (not a good symptom!).

Truth telling and full disclosure are essential to informed consent. Patient autonomy is a fundamental value in Western medical ethics. Patients must be given all the information they need to make an informed decision about their health.
Thanks for your feedback!

That’s great. Doctors have, more than once, made really a totally wrong diagnosis because they only had time to allow a patient to say less than 15 words or so. A lack of communication also causes huge distance between doctor and patient and makes patients more liable to rate their doctors negatively or even launch lawsuits because they see their doctors as nothing more than robotic prescription writers.

I’m doing well. Thanks, M.C. My father-in-law, however, has not been well and is now in palliative care at home. The family is rallying together to meet his increasing needs and to support my mother-in-law.
I had to take a brief break from writing to attend to the other important areas of life, but I will have a new post this week.

I’m sorry I didn’t see this response. I’m sorry to hear about your father-in-law. Sincere well wishes to you and your family.

You probably won’t like this comment but it really is a concern. The one thing that concerns me most (besides doctors having their running shoes on and one hand on the door knob), is that I heard on the radio that ministers have to keep updated before they are allowed to renew their licenses each year, but doctors are NOT required to write yearly updating tests “at all” which is probably why most are so far behind in the data that has been published in journals on the Internet for many years. (Then again… the ministers always did tell us that the soul was more important than the body 😉

While my 80 year old doctor who looks and walks like the old guy on the Carol Burnette show used to is sweet, I often wonder if he could pass such a test. Have to admit though, that since he is new (to me), he hasn’t yet been one of those to a wrong diagnosis though. (Then again, that could be because he hasn’t made any at all so far. 😉

Over the past two years, the College of Physicians and Surgeons of B.C. requires that all practicing physicians maintain sufficient continuing medical education. They have to complete a minimum number of hours of accredited programs (e.g. workshops and courses) and studying medical journals each year. This is change from previous years.

Hopefully, this will translate into you finding your physicians more informed and up-to-date.

When I teach medical students about the patient-doctor relationship, I not only ask them to strive to understand and empathize with patients but to show it in their tone, manner and actions. We can show that we are listening by asking for clarification to ensure our understanding, by sitting, by better eye contact and by keeping the hand off the door until we really are done!

How impressive! I wish what BC was doing was mandatory in all provinces, I have lived in several provinces as well as in Europe and already found BC doctors more advanced than most Canadian doctors to start with (although Europeans still beat Canadians). So many doctors are still quoting medical data that’s been passe for the last 10 years! Many times I’ve felt as though I had time traveled back into 18th century medicine. It’s so frustrating (not to mention deadly) when doctors are so far behind in knowledge. So many times I’ve told Alberta doctors two years in advance that certain medicines were deadly, and have explained why, as well as pointed out the links to prove my point, yet they would simply tell me not to read the Internet. Sure enough, two years later they would finally hear about it. By then hundreds of patients already suffered irreversible health damage. Vioxx was one of the things I pointed out, and Gadolinium used in MRI’s another. Both resulted in laughter. How shocking. There were others equally as dangerous.

Reasonable patients don’t expect their doctors to know “everything” but it’s upsetting when they refuse to even look at the information patients give them even when there are hundreds of articles written in the “latest medical journals” about it. Some doctors are so old fashioned they still believe that many patients can’t tell the difference between “Dick and Jane” sites versus valid Medical Journal sites. Others are so over confident that they insist that even journal articles written by the world’s top medical experts are written about professionals who actually know “less” than they do — even when many experts have confirmed the journals of the first.

I understand that no doctor likes patients who present pages of Internet data but at least if patients give them just one valid paragraph or two from an accredited medical journal website (showing the link to it) and the patient tells them there are hundreds of links indicating the same thing, you would think doctors would be interested enough to check out at least one or two articles anyway. Certainly more advanced doctors generally do respond positively to such information but sadly the most badly informed are those most likely to feel intimidated and least likely to check anything.

What makes things even worse is the fact that when a province is desperate to attract doctors, it appears they may be accepting anyone at all! I heard that in the United States doctors actually receive report cards from hospitals. Surely those who did receive bad report cards would flee to Canada who might accept them with open arms just as they do criminals. In this country doctors would not only “not” receive report cards, but would also be highly protected against malpractice as well as be assured a steady stream of patients no matter how severely lacking in knowledge they are. Congratulations, BC! You deserve a huge pat on the back for maintaining your lead over the other provinces. Even your budgeting appears far better than Alberta’s. I could comment a lot about that too.

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