Wednesday, March 14, 2012

Is there a doctor in the House?

Dr. Lisa Sanders believes that every encounter between patient and doctor is like a detective story. Patients get sick, bring their symptoms and concerns to their doctors, begin to tell their stories, and then BANG—after an average of 23 seconds—are interrupted by questions. The stories rarely resume as the doctors then take over and dominate the encounter.

The doctor will see you now
They may be paid to be medical detectives, but by failing to really listen to what patients have to say, most doctors never process the stories that often reveal what's wrong with the patient.
I went to hear Sanders speak last night at OSU where she also signed copies of her book, “Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis,” and cracked jokes about being the technical advisor for the TV program “House M.D.” In defense of the misanthropic medical genius who is the star of the show, Sanders said that Dr. House “clearly hates patients but loves diagnosis.” Figuring prominently in almost every episode are patient histories that form the basis for scenes in which House insults and badgers his residents as they collectively deduce what ails their patients.

Sanders laughed about how doctors seem to run all the tests themselves on “House.” “Do you know what would happen if I tried to run an MRI machine?” she asked.
Sanders is a clinical educator in primary care at Yale University and writes a weekly column for the New York Times on medical diagnosis. We should all be so lucky as to have a doctor like Sanders, who believes in the power of story and who apparently takes the time to listen to patients in her clinical practice.

The process by which a disease diagnosis is made is a linchpin of medicine. It often goes unnoticed and undescribed, yet is arguably the most difficult and most important thing doctors do. While physical exams and tests also figure in, patients would have better outcomes, Sanders said, if their doctors took the time—usually no more than an extra minute—to really listen to what they have to say.
I don’t think this advice should be limited to primary care docs. I’ve seen specialists who act as though they’re clairvoyant, and are untroubled by whatever symptoms I’m eager to describe but about which they can’t be bothered to hear. The assumption is that blood tests and/or imaging exams will tell them what they think they need to know. Genuine conversation is pointless.

Sanders made the point that once a doctor has heard a patient’s story and arrived at a diagnosis, that he or she should play the story back to the patient as they understand it. It’s an interesting proposition—and is totally unlike what most of us experience. Sanders has the research to show that this playback loop improves care through faster healing, less pain and better patient adherence to treatment regimens.
She didn’t say it quite so bluntly, so I will: Patients need to be heard. They deserve to be respected. They appreciate being partners in their care, as much as that is possible. And they don’t want their doctors to demonstrate House-like sociopathic tendencies. Some of us would gladly trade a little less medical genius for a little more attention.

Sir William Osler, the 19th century physician who has been called the father of modern medicine, was once quoted as saying: "Listen to the patient. He is telling you the diagnosis." Sanders is eager to remind us of that truth. And I will pass along the same message here. Patients should be encouraged to tell their stories. This intrusion of more humanity into medicine would be a good thing and could end up making us all a little healthier.

1 comment:

Anonymous said...

I’m envious of you being able to hear Dr. Sanders.
My doctor recently closed his private practice and joined a large clinic. Now when I meet with him he spends most of the time typing into and looking at his tablet. I doubt her ever really listens but transcribes. I had a doctor that once, before I said anything but hello, asked me when I broke my nose. There are some very good ones out there- somewhere.