Dr. Danielle Ofri’s recently released, What Patients Say, What Doctors Hear, reveals not much has changed since Dr. Jerome Groopman shared that most health professionals interrupt their patients within 18 seconds. That was 2007.
In this insightful and enjoyable read, Ofri illuminates the communication gaps and misses between provider and patient examining her own behaviors, that of colleagues, and sharing patient stories and communication studies. The book is written in everyday conversational language, not medical, and Ofri weaves stories and studies with heart and candor.
Given my work in diabetes, particularly in improving the patient-physician relationship, What Patients Say, What Doctors Hear is pure catnip.
Ofri is an internist at New York City’s Bellevue Hospital where she’s worked for more than two decades. She is also the author of six books, editor-in-chief of the Bellevue Literary Review and regular contributor to the New York Times.
Ofri is also a doctor unafraid to look behind the curtain at how medical training forms doctors, and she is painstakingly honest about her own interactions with patients. She writes, “When I turned the lens on my own practice, I observed that I fall short much more than I’d ever care to admit. I redirect the conversation within nanoseconds of the patient’s chief complaint. My approach to improving adherence is always education and reeducation, reading the chronic-disease riot act at nearly every visit. ... I verbally dominate nearly every patient visit...and I’ve never really stopped to think honestly about the biases that I bring into the exam room.”
Based on a study Ofri read about testing how long patients talk when given the floor, she tried it herself for a day. Much to her surprise most patients talked for two minutes or less. One, an Argentinean woman, Ms. Garza, typically full of complaints, whom Ofri was most frightened to extend the invitation to, only spoke for just over four minutes. How we experience time can trick us: Ofri thought it must have been at least twenty minutes.
And the benefit was undeniable. When Ms. Garza was done talking, both felt more calm than usual and Ofri could more easily address Ms. Garza’s ailments. Ms. Garza confirmed what Ofri had often read and wondered about, saying, “Just talking about all this has actually made me feel better.”
Unfortunately—and most of we patients can bear witness to this—doctors are uncomfortable with the “soft stuff” like communication, connection and empathy. These attributes are so simple and intuitive ‘says Ofri’ they can feel threatening to a doctor who’s spent decades and hundreds of thousands of dollars acquiring specialized medical knowledge.
And while evidence-based studies confirm their value, it’s hard for doctors to think these squishy skills can be as effective as pharmaceuticals. Nor do they carry the same satisfying heft of multicenter clinical trials with thousands of patients and huge budgets.
Ofri is also unapologetic when she states doctors need to shut up and listen - in order to make more accurate diagnoses, render more efficient testing and treatment, and elicit greater patient adherence.
“It's often hard for doctors to comprehend that there’s much more to adherence than a patient just opening a bottle and swallowing a pill... When doctors dominate the conversation and focus on the strictly medical issues of the visit—as opposed to the psychosocial aspects—the risk of non adherence to medications is threefold higher. When patients are experiencing particularly stressful life situations…doctor’s avoidance of these issues is associated with a six-fold higher risk of non adherence to medication.” (page 59)
The title of the book is perhaps best illustrated in this disconnect - when patients tell their story, it has a beginning, middle and end. Doctors, however, are trained to listen primarily for one thing - the chief complaint. It follows then that doctors interrupt patients quickly, and rarely hear the whole story.
I asked Ofri after all her research if and how she now reminds herself to listen. She told me, “If I’m not rushed I try to plan how I’ll speak to the patient beforehand and what approach I might take. Otherwise I try to give as much eye contact as possible and remind myself if I get frustrated to step back and analyze what is going wrong and how it might be fixed. If my better angels are on duty I sometimes have success. If not, I try to do better the next time.”
I have read many books written by doctors: Groopman, Abraham Verghese, Atul Gawande, Sandeep Jauhar, Paul Kalanithi, Rachel Naomi Remen and Ofri. Just as these doctors honor the delicate, fragile union between doctor and patient through their curiosity and witnessing, I strive to understand their world. A world which has become far too fast, far too mechanized and far too distant from the sense of care and service that took them into medicine in the first place.
In the end, perhaps writer Anatole Broyard, whom Ofri cites, speaks for all of us when he wrote, “I see no reason or need for my doctor to love me – nor would I expect him to suffer with me. I wouldn’t demand a lot of my doctor’s time: I just wish he would brood on my situation for perhaps five minutes, that he would give me his whole mind just once, be bonded with me for a brief space, survey my world as well as my flesh, to get at my illness, for each man is ill in his own way.”
Will anything change? Ofri cites small glimmers but it's hard to know. Yet to understand the landscape What Patients Say, What Doctors Hear is an important read.
Disclosure: I was not asked by anyone to write this review nor am I receiving any compensation.