{"id":45957,"date":"2017-02-19T02:38:19","date_gmt":"2017-02-19T07:38:19","guid":{"rendered":"https:\/\/asweetlife.org\/?p=45957"},"modified":"2017-02-19T02:38:43","modified_gmt":"2017-02-19T07:38:43","slug":"hello-hello-doctor-do-you-hear-me","status":"publish","type":"post","link":"https:\/\/asweetlife.org\/?p=45957","title":{"rendered":"“Hello? Hello, Doctor, Do You Hear Me?”"},"content":{"rendered":"
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Dr. Danielle Ofri\u2019s recently released,\u00a0What Patients Say, What Doctors Hear,<\/a>\u00a0reveals not much has changed since Dr. Jerome Groopman shared that most health professionals interrupt their patients within 18 seconds. That was 2007.<\/p>\n<\/div>\n

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In this insightful and enjoyable read,\u00a0<\/em>Ofri illuminates the communication gaps and misses between provider and patient examining her own behaviors, that of colleagues, and sharing patient stories and communication studies. The book is written in everyday conversational language, not medical, and Ofri weaves stories and studies with heart and candor.\u00a0<\/p>\n<\/div>\n

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Given my work in diabetes, particularly in improving the patient-physician relationship,\u00a0What Patients Say, What Doctors Hear<\/em>\u00a0is pure catnip.\u00a0<\/p>\n<\/div>\n

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Ofri\u00a0<\/a>is an internist at New York City\u2019s Bellevue Hospital where she\u2019s worked for more than two decades. She is also the author of six books, editor-in-chief of the Bellevue Literary Review and regular contributor to the\u00a0New York Times<\/a>. \u00a0<\/p>\n<\/div>\n

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Ofri is also a doctor unafraid to look behind the curtain at how medical training forms doctors, and she is painstakingly honest about her own interactions with patients. She writes, \u201cWhen I turned the lens on my own practice, I observed that I fall short much more than I\u2019d ever care to admit. I redirect the conversation within nanoseconds of the patient\u2019s chief complaint. My approach to improving adherence is always education and reeducation, reading the chronic-disease riot act at nearly every visit. … I verbally dominate nearly every patient visit…and I\u2019ve never really stopped to think honestly about the biases that I bring into the exam room.\u201d<\/p>\n<\/div>\n

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Based on a study Ofri read about testing how long patients talk when given the floor, she tried it herself for a day. Much to her surprise most patients talked for two minutes or less. One, an Argentinean woman, Ms. Garza, typically full of complaints, whom Ofri was most frightened to extend the invitation to, only spoke for just over four minutes. How we experience time can trick us: Ofri thought it must have been at least twenty minutes.\u00a0<\/p>\n<\/div>\n

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And the benefit was undeniable. When Ms. Garza was done talking, both felt more calm than usual and Ofri could more easily address Ms. Garza\u2019s ailments. Ms. Garza confirmed what Ofri had often read and wondered about, saying, \u201cJust talking about all this has actually made me feel better.\u201d<\/p>\n<\/div>\n

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Unfortunately\u2014and most of we patients can bear witness to this\u2014doctors are uncomfortable with the \u201csoft stuff\u201d like communication, connection and empathy. These attributes are so simple and intuitive \u2018says Ofri\u2019 they can feel threatening to a doctor who\u2019s spent decades and hundreds of thousands of dollars acquiring specialized medical knowledge.\u00a0<\/p>\n<\/div>\n

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And while evidence-based studies confirm their value, it\u2019s hard for doctors to think these squishy skills can be as effective as pharmaceuticals. Nor do they carry the same satisfying heft of multicenter clinical trials with thousands of patients and huge budgets.\u00a0<\/p>\n<\/div>\n

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Ofri is also unapologetic when she states doctors need to shut up and listen – in order to make more accurate diagnoses, render more efficient testing and treatment, and elicit greater patient adherence.\u00a0<\/p>\n<\/div>\n

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\u201cIt\u2019s often hard for doctors to comprehend that there\u2019s much more to adherence than a patient just opening a bottle and swallowing a pill… When doctors dominate the conversation and focus on the strictly medical issues of the visit\u2014as opposed to the psychosocial aspects\u2014the risk of non adherence to medications is threefold higher. When patients are experiencing particularly stressful life situations\u2026doctor\u2019s avoidance of these issues is associated with a six-fold higher risk of non adherence to medication.\u201d (page 59)<\/p><\/blockquote>\n<\/div>\n

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The title of the book is perhaps best illustrated in this disconnect – when patients tell their story, it has a beginning, middle and end. Doctors, however, are trained to listen primarily for one thing – the chief complaint. It follows then that doctors interrupt patients quickly, and rarely hear the whole story.<\/p>\n<\/div>\n

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I asked Ofri after all her research if and how she now reminds herself to listen. She told me, \u201cIf I\u2019m not rushed I try to plan how I\u2019ll speak to the patient beforehand and what approach I might take. Otherwise I try to give as much eye contact as possible and remind myself if I get frustrated to step back and analyze what is going wrong and how it might be fixed. If my better angels are on duty I sometimes have success. If not, I try to do better the next time.\u201d<\/p>\n<\/div>\n

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I have read many books written by doctors: Groopman, Abraham Verghese, Atul Gawande, Sandeep Jauhar, Paul Kalanithi, Rachel Naomi Remen and Ofri. Just as these doctors honor the delicate, fragile union between doctor and patient through their curiosity and witnessing, I strive to understand their world. A world which has become far too fast, far too mechanized and far too distant from the sense of care and service that took them into medicine in the first place.<\/p>\n<\/div>\n

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In the end, perhaps writer Anatole Broyard, whom Ofri cites, speaks for all of us when he wrote, \u201cI see no reason or need for my doctor to love me \u2013 nor would I expect him to suffer with me. I wouldn\u2019t demand a lot of my doctor\u2019s time: I just wish he would brood on my situation for perhaps five minutes, that he would give me his whole mind just once, be bonded with me for a brief space, survey my world as well as my flesh, to get at my illness, for each man is ill in his own way.\u201d\u00a0<\/p>\n<\/div>\n

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Will anything change? Ofri cites small glimmers but it\u2019s hard to know. Yet to understand the landscape\u00a0What Patients Say, What Doctors Hear<\/a>\u00a0is an important read.<\/p>\n