I had the opportunity to listen last week to a pre-recorded talk given by Abraham Verghese. Many of you may know him from his masterpiece, ‘Cutting for Stone’. I highly recommend this work of fiction but let’s move on, shall we.
Early in his medical career, Dr. Verghese got a reputation for treating those, well, (let me couch my words), ‘needy’ patients. You know them and if you are honest with yourself, you might not like them very much. They have seen every physician in a six state radius and all of their symptoms are vague. They take a boat load of medications and if you were to magically take away their illness, there wouldn’t be anything left. They seem to suck the light and happiness out of any room they enter and their families and friends have long since grown tired of their incessant complaints. They are defined by their illness.
Dr. Verghese had a whole lot of these patients and surprisingly he did well.
When a new patient approached him about treatment, he routinely set up two appointments. The first appointment was an hour in duration and all he did was listen to the patient tell their story from beginning to end interrupting as little as possible. The following visit, he performed a physical exam, ran tests and usually ended up ordering the same treatments that prior physicians ordered. Yet, they worked for the patient when they knew the physician had all the information he needed to treat them.
While the lesson of listening is very powerful, Dr.Verghese was actually talking about the lost art of the physical exam. His position was that it was impossible to talk and understand while also assessing a patient. Things got missed, he pointed out. That’s important, too. Nobody hears a soft systolic murmur while the patient is telling them when they last moved their bowels.
Everybody deserves to be heard. When we deny patients the right to be heard, we are cheating both the patient and ourselves of the reasons why most of us went into nursing all those years ago.
So if we really want our patients to get good care, we should listen. We need to consider how it would feel to be sick, alone and frightened and see the text message the nurse is composing is more important than us. We need to stop rehearsing our auto-response while our patients speak and think about how we should answer their specific questions inside of their specific circumstances. Nobody ever documents on time, anyway. The five minutes it takes to really pay attention to what the patient is saying and not saying, is not going to cause your paperwork to be late.
It is so easy. We all know this. And yet, I found myself running late for a meeting while I listened to a dysphasic stroke patient tell me about his time in jail and caught myself just before I cut him off and told him I had to run.
Can you imagine? I was so worried about my own agenda that I was willing to compromise patient care to get to my meeting. Wanna laugh? It was a quality assurance meeting. Somebody quick – send me the nurse of the year award.
It was important to this patient that I understood he had been in jail for armed robbery committed when he was 18 and that he had been out of jail and out of trouble since his release in 1988. He didn’t know I was a consultant. He simply didn’t want the people taking care of him to be afraid of him. I made sure everyone knew the patient was a good guy with poor taste in tattoos.
Another lesson to be learned here is that should you find yourself in jail, avoid tattoos on visible areas like the face. Just sayin…..
Thanks for the reminder Dr. Verghese. I was a better nurse, if only for the minute it took to listen to a patient. He’s doing well, by the way.
If y’all ever feel like getting lost in a novel that will take you places you have never been before, read ‘Cutting for Stone’. It’s an adventure that will leave you breathless and you don’t even need a passport.