It seems like at times there is a complete breakdown in listening – the recent “astroturf”-hijacked healthcare town hall discussions being a rather extreme example. Of course, this easily – and understandably – happens when emotions are high, and when the participants of any given discussion don't know each other. Time and place matter too; the internet is not always the best meeting hall, and sometimes (as we occasionally see on this blog), some participants will try to force a discussion that might more profitably happen somewhere else (e.g. on another website, or perhaps in person, or on “Jerry Springer”). I wonder if this is partly because most of us read much faster than we talk.
I like to get my news from the radio. I’m already on the internet too much to read it there; the local papers only deliver a few days a week (and NYT delivery is too spotty to be worth it); and TV news is too much stimulation (if it’s already bad news, I don’t want to see the footage of it)! But I can listen to radio news while I cook dinner, and the combination of narration and soothing mechanical activity works well for me.
Recently I happened to hear part of WHYY’s “Fresh Air”; the guest was Dr. Lisa Sanders, who writes the “Diagnosis” column for the NYT and is also a consultant for the TV show “House.” She has a new book out, “Every Patient Tells a Story.” In the interview, she talks quite a bit about diagnosis and the importance of physical exams, and it’s all pretty interesting stuff, but the part that struck me was about the importance of listening in making a diagnosis. Apparently, a couple of studies of doctor-patient interviews have been done which show that, as she says, “half the time, a doctor and a patient will not agree on what the purpose of the visit was about” (this is after the visit, when questioned separately). I thought, “this is something that we acupuncturists would do well to keep in mind.” Dr. Sanders went on to say that studies have shown that doctors interrupt their patients’ narratives after 20 seconds or less, on average; when the average narrative only LASTS two minutes. This REALLY struck me. Two minutes! Who needs 45 minute intakes? Sure, you have to ask some clarifying questions; however, questions that would lead to an acupuncture-oriented diagnosis (which is what you want when you’re doing acupuncture, right?) are relatively few and simple. So, say on top of two minutes of patient narrative you add three more minutes of “where does it hurt exactly” and “what makes it better/worse” and “does this hurt?” – and it seems to me that you can easily do a relatively thorough INITIAL intake in less than 10 minutes. That’s with some real good listening built in!
Clearly listening is a skill, and a difficult one to master; especially when what is being said is upsetting in any way. Naturally, as healthcare practitioners, we hear upsetting things every day; maybe this is why some of us (yours truly included) might have a slightly short fuse outside of the clinic. I don’t think I’m any better at listening than most people, and I’m terrible at giving advice – even when patients ask me point blank, I most often don’t have any to offer. (My feelings about “lifestyle advice” are pretty much echoed in this excellent post on the blog “Shapely Prose.”) Of course, just saying “keep coming back for acupuncture” can potentially sound a little self-serving. So mostly, I just try to encourage people (nonverbally as well as verbally) to trust themselves. The nonverbal part is important; it’s part of how we show we’re listening. I try to listen to patients’ words, and it also feels like listening to “tune in” to their body language, to their pulses, to the feeling under the needle. In lieu of advice, I try to help them listen to their inner authority – not because I believe so much in individual health, but because I believe in some kind of democracy. I hope that makes sense; I’m still trying to tune into what this all means, to find the words that you can hear, and that are still true for me.