Overheard last week at a busy internists clinic at an upscale South Delhi hospital...
Young woman: "I've been feeling tired and breathless lately...."
Doc: "You need a chest X-Ray, an ECG, a holster test [ambulatory monitoring of the heart]. Come back with the reports, we'll decide then if you also need a chest CT or a cardiac echo."
The visibly overweight woman heaved herself up muttering, "I don't think the vaastu of my new house suits me..." But by then the doctor had lost interest and buzzed for the next patient. Neither bothered to say goodbye.
When I ran into the woman at the hospital coffee shop, I asked her if she'd come back. She shrugged and said no, saying she'd get a second opinion when she found time. She had just moved to a new home near the very busy NH-8. "Traffic and construction next door keeps me up all night, I feel exhausted during the day," she confided. We exchanged numbers and she promised to update me on her health.
She did. It turned out that her heart and lungs were fine, her problem was anaemia. A fad-diet junkie, the young woman was perennially on restrictive diets that had led to levels of oxygen-carry haemoglobin to plummet to 6.5 gm/dl. The normal haemoglobin range for women is 12-14 gm/dl.
Add to that the stress of shifting home coupled with sleeplessness and pollutants traffic and construction, and she was left tired and struggling to feed oxygen to her starved lungs.
If the young internist had bothered to hear her out, as her friendly neighbourhood "doctor uncle" did, it would have saved her a lot of trouble and money and won him a loyal patient. But it was not to be, just as it is not for many of us.
If you ask yourself when was the last time you met a doctor who listened to you, you're likely to struggle to recall. If you've actually met one who did, it's likely he or she is the one you keep going back to for every real or imagined threat to your health.
Just as technical skills and rote learning are essential for diagnosis, so is empathy, which helps understand the physical and psychosocial dynamics that affect human health. Since only 7% communication is verbal, facial expressions, gestures, tone and posture all help to convey what the patient is going through. Unfortunately, few doctors believe patients may know something they don't, and most start prescribing treatment without waiting for them to finish.
Listening is not a passive activity but a skill that can be leveraged to improve treatment outcomes even when doctors are facing time constraints. A report by the Joint Commission - a nonprofit that provides accreditation to hospitals worldwide, including in India - communication failure, more than lack of technical skill, cause more than 70% avoidable complications and deaths in hospitals. Another US survey found that in over 60% of cases, patients misunderstood prescriptions even after meeting the doctor. And that on average, doctors interrupt patients's describing their symptoms between 18 and 23 seconds!
Suffering is subjective and listening helps doctors customise treatment. Simply asking the question, "Do you want more pain medication?" led to satisfactory pain control in 99% patients in emergency rooms, found a US study on new evidence-based protocol to treat acute, severe pain in hospital emergencies.
It was published online on Friday in Annals of Emergency Medicine (http://www.annemergmed.com/article/S0196-0644(15)00386-8/pdf).
Of the 207 patients enrolled in the study, all but two achieved satisfactory pain control within 2 to 4 hours without over-medicating them or causing side effects of nausea and vomiting. Almost all were satisfied with their pain treatment: 67% reported being very satisfied and 29% reported being satisfied.
And it's not just the patients who benefit. Several studies in the litigation-happy US show that patients are less likely to file malpractice suits against doctors who listened, made eye contact and didn't look distracted while the patient was speaking.
Patients may not always know best but they know can help doctors choose what's best for them, which in turn leads to better decisions and improved patient care.