Why It’s So Important For Physicians To Listen – The Patient’s Perspective

A recent qualitative study (structured interviews) of patients conducted at       McGill University School of Medicine underscores the importance of listening in physician-patient interactions.   In this study, patients were asked to identify the qualities of a good physician.   The following is a typical patient response:

“A good physician is somebody who will listen to what the problem is and explain to you what it is and what is being done.’’

When people were asked why listening by the physician was so important, researchers discovered three important themes that have apply to every provider today.

Theme #1 – Respondents (people/patients) believed that listening was essential if the physician was to arrive at the right (and credible) diagnosis. 

Representative Comments:

• ‘Physicians “should trust the person in front of them and hear what they’re saying. . .because I know my body better than anybody else.“

• ‘‘Listen to what they [patients] have to say; not just what other people wrote about them in the doctor’s notes.

• ‘‘[If] I feel that I haven’t had enough time with you to tell you exactly what my story is, even when you give me a prescription I’m going to say, ‘Really? Is this prescription right for me and for my illness? Or [is it] going to give me more complications?’. . .and I think sometimes that’s why you find patients will take it for 1–2 days and after that they forget about it, because they say, ‘He didn’t hear what I had to say about this pain.

Theme #2 – Listening is healing and therapeutic.

For years researchers have written about the therapeutic value of strong physician-patient communications.    Turns out patients recognize the same benefits.  For example,  a physician who listens and “validates the patient’s perspective or expresses empathy may help a patient experience improved psychological well-being—fewer negative emotions (e.g., fear, anxiety) and more positive ones (e.g., hope, optimism, and self-worth) ”

Representative Comments:

• ‘‘If a doctor doesn’t respect the patient, or doesn’t listen, the patient feels more worried and unsettled and this has an impact on their health.’’

• ‘‘Sometimes, listening to a person will cure half of your problem. . . like it takes two or three months to get an appointment. In those two–three months, you make your problem worse by thinking, ‘Oh maybe it is this, or that or that or that.’

• ‘‘if you listen to the patient and give the patient respect, what you are actually doing is helping that person take responsibility for their own health – that they are also in control of the healing process and are involved somehow. So the doctor has to not take all the power away from the patient.’’

For related patient (and physician thoughts) on this subject, check the following story and COMMENTS on CNN

Theme #3 – Listening can foster and strengthen the doctor–patient relationship if it is authentic

Representative Comments:

• ‘‘I want the doctor. . . to have empathy and to listen and to look into my eyes and to make me feel that for that short moment…you are hearing me, you are there for me, and you give me that sense that I matter

• ‘‘It still makes me angry when I think about how I was. . .how I sort of felt ridiculed for my looking into alternative options.’’

• I think they [physicians] should listen out of respect. Sometimes I think that caring and compassion can be patronizing, if it is insincere. You can still be arrogant and project this caring and compassionate facade.

Take Aways

Over all I was struck by the following as I read this study…particularly the respondent comments.

• People/patients in the study clearly recognized the link between effective listening (by providers) and quality of care.    Too often providers are quick to discount the accuracy or validity of patient perceptions of quality whether in the hospital or doctor’s office.  The comments reflected in this study suggest otherwise.

• Listen skills are essential to patient engagement and positive patient experiences.   To be engaging, providers must be “relevant” from the patient’s perspective.   To be relevant, providers must solicit and listen to what patients want to tell them.

• If listening is therapeutic and has the power to heal…does this mean that physicians who 1) do not solicit or 2)  ignore or gloss over patient input are not practicing at the “standard of care?”  Given that poor physician-patient communications is a leading cause of malpractice suits it would seem so.

• Health care providers (physicians and hospitals) would do well routinely do a “deep dive” into their patient satisfaction research to get a true and realistic handle on the quality of their provider’s listening and other communication skills.   I am not sure that the standard HCAPS and CHAPS survey instruments  probe physician-patient communications far enough.

That’s what I think.  What’s your opinion?

Source:

R. L. Street et al.   How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Education and Counseling, 2009. 74(3), 295-301.

J.  Jagosh et al.  Patient Education and Counseling.  85 (2011) 369–374

How One Doctor Creates A “Great Experience” For His Patients

[tweetmeme source=”Healthmessaging” only_single=false]I had a WOW experience yesterday when I accompanied my wife to interview a new doctor for her.   As some reader may know she is being seen by specialists At MD Anderson Medical Center in Houston for Stage IV lung cancer.   She has not had a local oncologist for the past 6 years…but she does now.   And we both love this guy!
 
You need to understand that I have been very underwhelmed by the local oncologists I had met up till now.   I am sure they were clinically proficient…but as a group not a one could muster a smile….or any sense of interest or curiosity in my wife’s medical condition.  I held out little hope that this new doctor would be any different.
 
After being ushered into the exam room, a Physician’s Assistant came into the room to get smart about my wife’s history and records (which she brought).   Three things surprised me about the PA.  1) She was incredibly thorough actually reading the radiology reports and reflecting with my wife on what she learned, 2) her empathy – as she read the reports she actually used terms like “bummer” when she read how my wife developed pneumonia during her treatment, and 3) she faithfully summarized the results of her review to the doctor before he came in.  In other words – the PA listened and heard what my wife shared with her!
 
Now enters the doctor.   He has a warm smile on his face while he extends a hand to my wife and me.  He says just enough for us to know that he has talked to the PA.  He asks my wife to sit on the exam table and does a physical exam (also a rare event these days).
 
He then got her down from the exam table into a chair and sat down himself facing us.  He asked my wife why she was there and what she wanted to accomplish.  After all she had world class docs back in Houston.   He asked her why she thought her docs in Texas had stopped her oral chemo for 3 months.   He asked why they suggested she start some of her care locally instead of continuing to go down to Texas.  If the point isn’t obvious…the doctor seemed to value her opinion of what was going on with her care.
 
He empathized about it is like to be treated in a world class academic medical center….often long on experience but sometimes short on bedside manner.    He volunteered that given my wife’s situation he saw his role as collaborator with her primary cancer care team in Houston.   He would take care of her needs locally and advocate on her behalf when needed with the “experts” at MD Anderson.   And I was worried that this guy’s nose would be out of joint given her continued relationship with her docs in Houston.    The visit ended with a hug between my wife and her new doctor.   Something my wife told the doctor she was used to from one of her Houston docs.
 

What we like about my wife’s new doctor is his “mindfulness.”  
 Specifically we liked the doctor’s attentiveness, curiosity, flexibility, and presence – all qualities of mindfulness according to note researcher Ronald Epstein, PhD.

 
We have already established the doctor’s attentiveness to the details of my wife condition.   His curiosity was evident by his questioning of my wife’s opinions on how her case was being managed.   In addition, the doctor enjoyed working with lung cancer patients.  The doctor flexibility was evident from his willingness to play “second fiddle” to my wife’s doctors in Houston.   Finally this doctor was “present” at all times during her visit.   He listened, picked up on “cues” from my wife and I, anticipated my wife’s needs and never looked at his watch.
 
So the next time you visit your doctor…or you visit with a patient, you might think about “mindfulness.”
 
It doesn’t take any more time I suspect…but can make all the difference to patients and their caregivers.  Heck I was so impressed that I wrote a blog posting about it!
 
Sources:
 
Epstein RM. Making communication research matter : What do patients notice , what do patients want , and what do patients need ?  Journal of General Internal Medicine. 2006;60:272-278.