Can doctors be better listeners? The art of being present

I had just had my second child and I
noticed that there was kind of an abnormal area in my left breast and the
imaging workup showed that there was a about a seven or eight centimeter mass
there. I still wasn’t that worried. This is what I do for a living. I diagnose
breast cancer. This probably isn’t gonna be my story. They did a biopsy of the mass and the
next day I was back at work waiting front my colleague to come knock on my
door and tell me the results of my biopsy. Eventually she did come to my
door. She had a colleague with her and I knew
the second that I saw the two of them together that the colleague was there to
help her deliver bad news to me. It was me this time that was getting a
cancer diagnosis. I learned firsthand really what that felt like. A major part of what we do as physicians
involves understanding what’s important to a patient, understanding how a
diagnosis or treatment plan is going to affect that person’s life, and being able
to communicate why we think that a certain clinical decision might be the
right one for a patient and for all of those
things empathy is critically important. We do have research to tell us that
empathy is important. We know that having a trusting relationship if the patient
is perceiving that trust that then translates into gains in patient
satisfaction, provider satisfaction. It’s associated with better quality outcomes.
Listening is at the heart and core of empathy and then derivative from that is
being able to place the patient’s experience in a broader context to
more fully understand the implications of the disease, of the patient’s life on
their well-being and the well-being of those around them Being a patient opened my eyes to a lot
of what patients go through but I don’t think that it’s the only way you can
gain understanding about what it’s like to be in someone else’s shoes. I think
there is some empathy built into the character of young physicians as they
enter a field that really is a lot about empathy but it’s unfortunate
sometimes the system isn’t built to capture that and nurture that
in a positive way. Technology is now interwoven into almost everything that
we do in clinical care and I think that can at times detract from human
connection and the interactions that many of us went into medicine for. There
has been over these past decades a rapid expansion of biomedical knowledge but in
some cases that knowledge and the way it’s been applied and the technology
accompanying it have served to distance care providers from their patients. Just
as much as we’re teaching the biomedical sciences, basic sciences during the
preclinical years and the clinical years from the medical students, we need to
equally be thinking about how to build their listening skills and their ability
to connect to patients, their ability to build that empathy with their patients.
Medical students you know learn how to examine the patient in their first two
years of medical school and then they arrive on the wards and they find to
their dismay I think that the currency on the wards doesn’t revolve around the
patient as much as it does around the computer which and led us to
particularly embrace something we’re calling Presence. It’s full name is
Presense: the art and science of human connection. And it really is about trying
to foster interdisciplinary work in order to enhance the experience of being
human. I have been really appreciating what presence has been doing for us.
A lot has come out of presence, one in particular is the Presence Five
initiative. The Presence Five study is an initiative that’s bringing together
researchers from the different disciplines across Stanford and the
School of Medicine and our goal is to identify specific discrete actions that
clinicians can take to be more fully engaged in the moment
with patients. Making a young physician present is really a matter of undoing
a lot of the things that the old physicians have left them as a legacy
but I think we now have a new mandate to embrace that. Not only is the patient at
the center but the human being is also in the center. My own personal journey
opened my eyes to a lot of what patients go through and I think a lot of the
benefit I brought back to my practice was sharing this story with other
physicians or other physicians in training, other patients. Medicine is not
a factory, it’s art and a science. It’s two human beings coming together ultimately
and one human being is in a state where they require more than the science. They
require compassion, they require understanding. There’s a subtext there
we’re dealing which is “please help me.”

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