I’ve got to admit. I was disappointed by the meager response I received to my last article.  While only a few of you sent me their ideas of what it takes to be a good doc, the few who responded agreed that a “good” doc has to be a good listener.  One reader sent an inspiring quote, “The biggest communication problem is we do not listen to understand.  We listen to reply.”

Take a minute and think about it.  How fast does your doc interrupt you when you are telling him/her about how you feel?  There are multiple studies posted to the internet showing that, on average, docs interrupt their patients’ story in eleven seconds.  What is truly regrettable is that, when I started in medicine in 1979, statistics showed the identical 11 second interruptions.

 “The biggest communication problem is we do not listen to understand.  We listen to reply.”  If I’m listening to reply, eleven seconds works.  In eleven seconds, I think I’ve got the gist of what you are saying, I then cut in and start into my diagnosis and treatment plan.  If I’m listening to understand, I let you finish telling your story and uncover facts I missed in the first eleven seconds.

So, why aren’t doctors given courses in listening?  One of the things that impressed me during my first month of residency was an exercise in listening.  Our director played a cockpit recording from an airplane that crashed due to a miscommunication between the pilot and co-pilot.  We spent about an hour analyzing what happened and another hour discussing how it could have been prevented.  That was the extent of my listening training!

While listening to understand is essential in every facet of life, it is particularly critical in medicine. It is also time consuming and, regrettably, time is money. Yep, I had salaries and bills that had to be paid. In a perfect world, docs would be paid by the minute.  You need 60 minutes; you get 60 minutes.  In the real world, Medicare and the insurers pay an hourly rate that doesn’t come close to covering the overhead of a modern medical office.

Do you have a solution?  I did but very few patients liked it.  I learned to limit the number of problems I would listen to during an office visit.  It works like this: 

Patient – “Doc, I’m having problems with a cough.  Oh yeah, I also have acid indigestion.  I almost forgot to tell you, I pee every 2 hours.  My nose is congested …

Me- “I’m sorry you are having so many problems.  I’m going to step out of the room for a few minutes.  Please make a list of everything that’s bothering you and then prioritize your list.  Today, we’ll deal with items one and two.  We’ll see you in a week and follow up on one and two and start on three and four.”

Patient- “Oh, by the way, I forgot to put chest pain on the list.  I’m sure it’s just indigestion.”

Patients who had saved up a lot of problems did not want to wait a week or two to resolve all of their issues, despite the fact that the cough started last year, the bladder issues started 6 months ago, etc.  All too often, the patient’s priorities did not match mine.

At the end of a twenty-minute visit in which we developed a list of problems to be addressed, had addressed the most pressing problems and had arranged for the future handling of unresolved issues.  The patient, while standing at the discharge desk, complained that the doc didn’t listen to him and did nothing for him.

So, when asked how I would fix our broken medical system, I would answer, “We do not listen to understand.  We listen to reply.”  Before trying to fix our broken system, we need to do a lot of listening to develop an understanding of what people truly need.  Unfortunately, only 4 out of a hundred readers responded to my first question, “What makes a good doctor and what makes an excellent doctor?”  Now, what makes a good patient and what makes an excellent patient?

Jokes about miscommunications:

My wife and I have such a wonderful marriage. I always know what she is thinking because she always tells me what she’s thinking.

She always knows what I’m thinking, because she tells me that, too!

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