Do you ever think about the privilege that our patients give us when they entrust us with their stories? Or the privilege that we have as a profession of having the TIME to listen? I know that is something that I have lost sight of at times, whether it’s due to the busy-ness of a crowded schedule, my own biases (SURE, you have a high pain tolerance…), or other stressors or things that make me feel too busy to sit and listen.
I think the privilege part of this has become more and more apparent to me as I have begun to work with individuals with pelvic floor dysfunction. Suddenly, I became the healthcare provider who was trusted to engage in a dialogue with them about intimate details of their lives, and whose responsibility it was to ask them detailed questions about their sexual experiences or bathroom habits. When I first trained to treat pelvic floor dysfunction, I was nervous; how would people feel if I suddenly started asking them these very intimate questions? Would they think it was weird that their physical therapist wanted to talk in detail about their sexual, bathroom, or birth experiences?
What I found-much to my surprise, to be honest-was that patients not only accepted my questions, but welcomed them, and the floodgates of information opened. In fact, they were thrilled to discover a healthcare provider with whom they could discuss these topics and find knowledge, answers, and compassionate troubleshooting. Many of them have told me that they have spent more time talking with me than with all of their other healthcare providers combined in the year up until that point.
Even if you don’t work with patients with pelvic floor dysfunction and don’t need to get quite as detailed in your questioning about these topics (though I would contend that you should still screen these functions!), you are still being trusted with your patient’s story. Even if this is your 452nd low back pain patient this year, this is the one and only back that Mary Sue has ever had-and maybe her first experience where a provider has sat and listened carefully and attentively to her symptoms. I know it can be easy to start thinking “Oh yes, I know what is going on, because I have seen so many of these patients this year”-this is your opportunity to make a huge difference with THIS patient, and it starts with careful listening and smart questions. Whether doctors should take better histories or not is a whole other can of worms that we could open, but what it boils down to is: you can’t assume that this patient has had a comprehensive history (or physical exam!), and you have the privilege and opportunity to provide this important first step in patient buy in.
One of the things I was told as a student has continued to stick with me throughout the years: “Listen to your patients, they will tell you what is wrong with them.” I have certainly found this true in my years of practice! And how many times have you heard repeated the refrain, “I told my doctor XYZ but he/she didn’t believe me/didn’t listen to me.” It is sad that this is the expectation of our healthcare system-that the provider may or may not listen and certainly won’t take into consideration the chief complaint of the patient! Now of course, there is a balance here somewhere; we do have to be efficient with our time as well.
What are some of the ways that you personally have found to be helpful for really getting deep into patient’s stories in the amount of time you have, and truly listening, not just to what you expect to hear, but also to what the person is actually saying? Have you found any helpful “resets” for yourself when you start to get into the cynical headspace that says “I know this person’s story, it’s the same as the stories for the last 10 people I evaluated with this diagnosis”?