Listening to the deep and real story behind a problem… and why “technical efficacy” and “following the textbook” may not be enough.

The book by Audrey Young, MD. (2007) “What Patients taught me”, is nicely written and made with love to her medical profession. She finishes the Preface of this book with the following sentences:

“I wrote and rewrote. Finally I recognized that the only thing to really make doctoring a human act is time spent with patients. Patients teach things that the wisest and the most revered physicians cannot, …” (p. x)
The book is made of short-stories about her career and her patients narratives throughout. It focuses on their description and how these accounts had an impact on her practice as a clinician. She talks about what some of her best colleagues did when treating their patients, what made them better and different. She highlights a variety of experiences in which expertise was accompanied by the powerful tools of both listening and truthful regard for the real individuals inside their “patients” and their circumstances.
Understanding is sometimes core to explaining why some medical treatments do not work in practice, why some “clear solutions” may not been put into practice, why in some cases the adoption of the “clear solutions” may damage rather than improve the problem at hand.

She talks about the lives of her patients and sometimes about their carers. How difficult is for a health worker to communicate bad news to them, but also for these clinicians to accept and endure the bad news affecting their patients.
Overall, the big important message of the book is that medical doctors can only get better if they engage with the story behind the illness or the problem their patients face. The reasons given are deep-rooted in the human nature of their profession, of course. But also call for attention over the fact that quite frequently treatments and medications may dismiss other important considerations affecting the patient’s life and environment. A medical doctor cannot change these lives and environment on their own, but clinicians can make the treatment work better given the specifics of the patient, those specifics which are hidden away in the patients’ story.
While reading the book I though of myself as a patient in the NHS. I thought of how lucky I have been by encountering a few remarkable good clinicians and supporting nurses while dealing with cancer and other illnesses. Most significantly, I have also been made aware of how little time the great majority of doctors, nurses, therapists and support practitioners have for “truly listening” to their patients and their caregivers. The financial and cultural constraints imposed on the NHS have made almost impossible for their particular providers to dedicate real time and sincere attention to the increasing number of patients they receive every day. The waiting list have been increasing non-stop, and this burden affects everyone involved, patients, carers, doctors and nurses… There is no time to listen and to get to know why “solutions” may or may not work in any unique specific case.
It seems apparent that medication tends to work faster and is considered more “efficient” than prevention because prevention requires time to get to know, to understand, to adapt, to persuade, to accompany the patient and the carer. There seem to be no time for important behaviour because everyone is engaged with the urgent action that come with modern fast-speed life style, with financial pressures and with the general disregard for things that used to be important in “the old times”.
While reading I also reflected in the close similarities shown by the “lack of time” situation faced by clinicians and the conditions faced by educators, managers and directors of companies, and us all as a human being (roles in which I am actively involved). We all live in a world in which time and information have become the most valued commodities. We expect “everything” to be there, available at the click of a bottom. We expect that all troubles will be solved instantaneously. We are pushed to care only about “today” at an increasing speed.
The above reflection moved me to the consideration of the long-term belief that we all become better in what we do if we just take a bit of time to sincerely listen and get the “story” behind the person, the problem, the organisation, the member of the family we are trying to assist.
I know that giving time to everything and everyone is not possible. However, we have a choice to dedicate our time to get to know what and with whom we are relating to. For clinicians that extra minutes of truly listening to their patients could safe unnecessary appointments and treatments later on. For managers to listen to their peers and their employees, customers and suppliers could guard them against costly business mistakes and decisions. Educators listening to their students may motivate them to really learn, rather to just passing exams. Non-executive Directors listening to different stakeholders may discover where the real challenges for the organisation exist.
Are we able to choose when it is key to slow-down and listen? Are we able to really learn from others and their circumstances? Are we able to slow-down to reflect, to adapt and to consciously enhance what we are doing? Are we aware that we have a choice?
Patients and carers are worthwhile listening to. Students, co-workers, employees, members of our own families, everyone may have a valid and useful story to tell… if we just have the time to really listen.

Young, Audrey, MD. (2007) What Patients taught me. Sasquatch Books. US.


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