Learning to Listen to Patients’ Stories

The epidemic has been a time of painful social isolation for many people. Some locations may be isolated as hospitals, where patients are surrounded by strangers, subject to invasive tests, and associated with an assortment of beeping and gurgling machines.

How can the experience of receiving medical care be made more welcoming? Some say that sympathetic ears can go a long way in helping patients going through the stress of being hospitalized.

An urgent care physician in Mountain View, California, Dr. “This is even more important when we can’t always see patients’ faces or touch them, actually hear their stories,” Antoinette Rose said. Many patients are ill with Kovid.

“The epidemic has forced many caregivers to embrace human stories. They have no choice. They become ‘family’ at the bedside, ”Dr. Andre Lijoie is a medical director at York Hospital in Pennsylvania. To slow down time, to take a breath, to listen, to assist doctors, nurses and other patients in their care.

Both doctors find their inspiration in narrative medicine, a discipline that guides medical practitioners in the art of listening deeply to those who come to them for help. Now in the United States, about 80 percent of medical schools are taught some form of Narrative Medicine. Students are trained in “sensitive interviewing skills” and the art of “radical listening” to enhance interactions between doctors and their patients.

“As doctors, we need to ask those who come to us: ‘Tell me about yourself,” Dr. Explained by Rita Charan, who founded Columbia University’s pioneering narrative therapy program in 2000. “We’ve gotten out of that habit because we think we know how to ask questions. We have a list of symptom questions. But we have a real person in front of us who is not just a collection of symptoms.”

Columbia is currently training online for medical students such as Fletcher Bell, who he says helps the course see his future role as a healer. As part of his narrative medical training, Mr. Bell virtually kept in touch with a woman who was being treated for ovarian cancer, Sharing experience that he described as heartbreaking and beautiful.

“Just listening to people’s stories can be therapeutic,” Mr. Bell said. “If there is fluid in the lungs, you dry it. If there is a story at heart, it is important to get it out as well. It is also a medical intervention, not just one that can be easily prescribed. “

This more personal approach to medical care is not a new art. In the non-distant past, general practitioners often treated several generations of the same family, and they knew much about their lives. But as medicine became increasingly institutionalized, it became increasingly and impersonal, Dr. Charon said.

Specialist doctor visits nThe owl lasts for 13 to 16 minutes, Which will typically pay for insurance companies. a 2018 study published in General Internal Medicine Journal It was found that most doctors at the prestigious Mayo Clinic did not even ask people the purpose of their visit, and they often interrupted patients as they talked to themselves.

But this fast-food approach to medicine requires something, says Dr., assistant dean of medical education at the Kaiser-Permanente School of Medicine in Pasadena, California. Dipu Gowda, who at Columbia, Dr. Was trained by Charan.

Dr. Gowda remembers an elderly patient whom he had seen during his residency who was suffering from severe arthritis and whom he had felt angry and desperate. He came to visit his office. He then began to question the woman and listened with interest as her personal history was revealed. She was so moved by the story of her life that she asked him permission to take pictures of her outside the hospital, which she granted.

Dr. Gowda was particularly struck by a picture of his patient, cane in hand, restrictive of his walk-up apartment. “That image represented for me her daily struggles,” he said. “I gave him a copy. It was a physical representation of the fact that I cared about who he was as a person. His pain did not go away, but later visits had a lightness and laughter that was not there before. There was a kind of healing in that simple human belief. “

Dr. Gowda said some working doctors have leisure time outside the clinic to deeply examine their patients’ photographs or their life history. He relied more on a doctor who was motivated to follow his instructions and to return for follow-up visits, he said.

Some hospitals have started conducting preliminary interviews with patients before beginning clinical work to get to know them better.

Thor Ringler, a family doctor, started “My life, my story” program William S. in 2013 in Madison, Wis. At Middleton Memorial Veterans Hospital. Professional writers are hired to interview veterans – by phone and video conference since the onset of the epidemic – and to draft a short biography that has been added to their medicals. Recorded and read by their attending physician.

“My goal is to be heard in a large bureaucratic system where they are not always heard,” said Mr. Ringer, who was vets with a way to provide.

The program has spread to 60 VA hospitals, including Boston, where over 800 veteran stories have been compiled over the past three years. Jay Boston, nurse manager of the VA Boston Healthcare System, said that these biographies often provide important information that can help direct treatment.

“Until they have access to the patient’s story,” Ms. Barrett said, “health care providers do not understand that this is a mother who is caring for six children, or who has the ability to pay for the drug There are no resources for, “or it is a veteran who has severe trauma that needs to be addressed even before talking about how to manage pain. “

Dr. Lewis Mehl-Madron, a family physician who teaches at the University of New England at Biddeford University in Maine, is studying veterans who were undergoing treatment for pain. Those who were asked to tell about their lives experienced less chronic pain and the relationship with their physician was greater than those who did not. The doctors who settled the stories also did more job satisfaction and were subject to less emotional irritation, which has become a particularly worrying problem during the Kovid epidemic.

The timely demand for health care workers has never been higher. But advocates of narrative therapy say that it takes only a few moments to build an authentic human relationship, even when communication is online, as it often does now. Dr. Mehl-Madron argues that remote videoconferencing platforms such as Zoom can actually make it easier to track down vulnerable people and sort out their stories.

Derek McCracken, a lecturer at Columbia University who helped develop training protocols for using narrative techniques in telehealth, agrees. “Telehealth technology can be a bridge,” he said, “because it is an equalizer, forces both sides to slow down the conversation, be sensitive and listen carefully.”

Dr. The key point for Mehl-Madron is that when people are asked to talk about themselves – whether it is in person or onscreen – they are not reaching out to the doctor themselves just to decide. They are actively engaged in their treatment. “

“Doctors can be replaced by computers or by nurses if they feel their only role is to prescribe drugs only,” he said. “If we want to avoid the fate of the dodo bird, we have to engage in dynamic relationships with patients, we have to put the symptoms in the context of people’s lives.”

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