COMMENTARY

The Doctor-Patient Relationship II: Not Listening

Ursula Snyder, PhD

Disclosures

December 29, 2008


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"Gee, I wonder why patients have less confidence in their doctors. I get about 15 minutes for a consultation, a doctor who rarely even [pretends] to listen to me and who seems not to care...drugs with side effects my doctor never bothers to discuss and sometimes denies...."
Comment to blog "Patients and Doctors Start Talking.[1]"

It's not quite fair to blame the doctor for not listening. Powerful obstacles exist: having to see too many patients in too little time; the overwhelming amount of medical information demanding to be digested; and for (North) American medicine, in particular, a culture and training that elevates the expert and aggressive action, or assertiveness, in the name of serving the patient.[2,3]

Consider the scientific method of research, the foundation of modern medical science. A question is not so much asked as proposed,usually on the basis of previous research, and a hypothesis (an assertion) is made about what the answer will be. The perspective of listening to the data may be compromised because the emphasis is on determining whether the initial assertion is true or false. This kind of thinking may further understanding of disease processes at a biological level, but it can be problematic when it works its way into the interaction between a doctor and a patient; it often does and both may fall victim to the "tyranny of diagnosis.[4]"

As a culture, we seem not to know how to listen -- or refuse to. Listening to "properly hear" the other requires a lessening of the dominance granted expertise for a more vulnerable openness to the voice of the other.[3] Listening requires attentive presence.

Developing some capacity for stillness and withdrawal from the desire to act and react -- to be assertive -- can be aided by any of the variety of disciplined meditative practices. These are often prescribed to patients to relieve stress, but for the sake of the doctor-patient relationship, they might be prescribed to the doctor. For, "what is not listened to remains inaudible and consequently 'unheard of' [and] susceptible to degradation.[5]" When this happens, a doctor may miss an opportunity for healing, or worse, he risks failing the patient.

That's my opinion. I'm Dr. Ursula Snyder, former editor, Medscape Women's Health.


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