Chapter 19: How to listen to your patients – so they will listen to you !
|There are people who, instead of listening to what is being said to them, are already listening to what they are going to say themselves. Albert Guinon.
One of the commonest complaints patients have about doctors is that they are too distant and uncaring. Perversely, many doctors still pride themselves on their detachment and equanimity - and distancing oneself from the patient is one of the first skills we learn as medical students !
However, medical practice is not an either-or situation, and doctors need to practise both science and art, reason and intuition, attachment and detachment, equanimity and empathy. These are not mutually exclusive – and the good doctor needs to find the right balance !
Unfortunately, we do not encourage our medical students to develop their emotional skills, and medical college usually drains whatever natural empathy students have. Students get marked for their academic excellence, cramming ability and surgical virtuosity – not their ability to establish a rapport with their patients ! Medical college professors rarely demonstrate empathetic skills – so who are students going to learn from ? By overworking residents and forcing them to cram tomes of scientific information, we often end up dehumanizing them . This means that after 6 years of medical college, instead of producing doctors who should be able to understand a patient’s pain and suffering, we turn out unfeeling surgical automatons - what a shame !
Some doctors are naturally blessed with empathy , while others need to learn it. However, it can be learnt and taught – and is as important as learning to tie a surgical knot and to start an IV line ! Time , age and experience often bring empathy along with serenity – and doctors who have suffered themselves ( or whose family members have experienced suffering) are much more likely to be empathetic than others.
One of the best ways of developing empathy is to become a patient yourself ! When physicians fall sick themselves, they learn the value of empathy the hard way ! Seeing things from the other side can be very educational – and many doctors are quite shocked to realize how badly the medical system treats patients in general. Unfortunately, they only learn this when they are at the receiving end, but many do improve their own bedside manners as a result of this experience ! In fact, a medical school in the US admits their medical students as patients in a hospital ward for 2 days, so that they can experience firsthand how it feels to be a patient in a strange , hostile and threatening environment.
Reading books written for patients can also be very educational. The consumer health literature has now become voluminous, and unlike medical text books, these extensively cover the emotional effects of the illness and how to cope. Since these books have been written for patients, they are patient-centric, and eloquently present the patient’s view point.
Books written by patients which describe their first-hand experience are particularly valuable, and can serve as an eye-opener if you try to feel the story as the patient feels it ! Just as artists learn to see by drawing, so doctors can learn empathy by putting themselves in their patients’ place. " Pathography” - the stories of illness from the inside - can help nourish empathy.
The internet is also very valuable, since there are so many personal websites which present the patient’s experience with his illness. Online bulletin boards , chats , mailing lists and newsgroups which invite patient participation are all very useful as well. Not only can you contribute your wisdom as a medical professional , if you keep an open mind, you can learn a lot about what it feels like to be in the patient’s shoes. Unlike Indian patients, many in the West are very articulate and demanding – you can learn a lot from them !
Is there a downside ? Empathetic doctors can sometimes lose their objectivity, and when you get attached to your patients , their grief becomes your grief, and their sorrow becomes your sorrow. Is this bad ? I don’t think so ! I think this is part of being human, and we should allow ourselves to experience feelings ! As a doctor, we have the unique privilege of sharing our patient’s innermost thoughts, and we should try to make the most of this privilege, rather than try to wall ourselves off.
Learning empathy is very valuable in improving the medical care you provide. Just talking to the doctor can be therapeutic for many patients, and conveying empathy lies at the heart of a physicians supportiveness. We need to remember that doctors are active healing agents – and often far more potent than an antibiotic !
It is true that there will be some days when you will find it much easier to respond to your patient’s feelings – and some days ( when you are feeling burnt out ) when you couldn’t care less ! Also, some patients are much easier to empathise with than others. However, if you do try to consciously develop your empathy skills, this will help you to take better care of your patients, become a better doctor – and even more importantly, become a better human being !