A wise and experienced medical school professor once said “listen to the patient, they will tell you what is wrong with them.” As profound as his words were, it took me many years to really “get it.” We in the medical profession tend to drink from the cool-aid of high-tech tests, gadgets, and procedures. They’re hot. They’re sexy, and most importantly they pay big bucks. Listening is old school, passé’ and it’s not codable, billable, or re-imbursable. Unfortunately, the system does not respect the art of listening. It does not adequately pay for a listening physician, and in fact it punishes them. I’ve known bright, kind, caring, compassionate physicians, dearly loved by their patients, who were fired from their jobs basically for being good listeners. They took too much time with patients. They weren’t productive enough. They didn’t churn patients as fast as their colleagues, so they didn’t bring in as much revenue for the practice, and as a result they were let go. Both they and their patients paid the price for a system that devalues listening. Unfortunately this penalty for listening falls disproportionately on female providers, but that’s a story for another day.
Ninety-nine percent of doctors I have known in my twenty something years in health care have been hard working, conscientious, kind, caring, compassionate, smart, well trained, and well-meaning providers who have gone to work every day with the goal of helping and healing their patients. I have the ultimate respect for their talents, and dedication to their noble cause. However, in this day and age of industrial, big business medicine, driven by government, insurance companies, and drug companies, the average primary care physician has about seven to ten minutes per patient. What is a physician to do when a patient comes into the office and gets out their internet printout and a list of symptoms that includes weakness, fatigue, brain fog, abdominal pain, hot flashes, night sweats, low libido, and insomnia? Most likely they’ll get a few perfunctory laboratory tests and the then the doctor will get out the prescription pad. In this case it’ll probably be an antidepressant a sleeping pill, and maybe a pain pill. It’s the well-worn symptom-pill, symptom- pill revolving door, which inevitably leads to more pills to treat the side effects of the first pills.
Stop the madness! The system is broken. It’s a set-up for failure for the physician and the patient. The physician does not have the necessary time to listen to the patient. Therefore they will rarely get to and treat the root cause of the problem. They’ll only put Band-Aids on the symptoms with more pills, which is a prescription for side effects and often a lifetime of unnecessary suffering.
The power of listening is that it can be such a compelling tool in finding and treating what is at the root cause of the patient’s problems. The power of the prescription pad is that it’s the accepted tool of modern western medicine. Unfortunately, after a lifetime of conditioning, it also meets many patient’s expectations (especially with direct to consumer advertising by the drug companies). Practice managers also love it because it helps meet the ten minute deadline to get the patient out and shore up the financial bottom line.
Just yesterday I had a patient in my office who was in tears because she had been suffering for ten years with profound fatigue. She had been to many physicians. She did not feel as though her doctors had ever taken her seriously. The tests were all “within normal limits”, so it must be all in her head. After ten years of searching for an answer to her symptoms she never felt “listened to.”
In fairness to doctors, the issue of non-listening goes well beyond the medical sphere. As parents, friends, brothers, sisters, husbands, wives, politicians, teachers, and world leaders, we would all benefit from being better listeners. It seems to me to be one of the most important skills that a human being can learn. We teach reading, writing, and arithmetic to our kids but we hardly ever teach them about the art of listening.
Such a class should be a part of the curriculum at every stage of ones education. Especially in medical school, there should be an emphasis on the art of listening. It is so fundamental to what we do as healers. It is diagnostic as well as therapeutic. One might say the classes are not needed. “Listening is easy. Anyone can do it” they might claim. But then again, if good listening is so easy why is it such a rarity for a patient to find a medical provider who is a good listener?
In summary, the most powerful tool in medicine is neither a scalpel, a drug, nor an MRI scanner. It is an engaged, caring, compassionate provide, patiently and earnestly listening to the wants, needs, joys, and suffering of the patient in front of him or her, who has honored the healer by entrusting them with their heart, their soul, their mind, and their body. Let’ all strive to be better listeners.
