8/17/2023 0 Comments Active listening skills checklist![]() ![]() When patients feel like hostages, the ideal of shared decision making is a pipe dream. Most physicians certainly don’t want patients to feel like hostages, but the patients often do. Patients learn roles, too: adhere to the doctor’s plan, squelch errant thoughts that might sound foolish, don’t ask too many questions, defer to the expert, be “a good patient.” In a new article we co-authored with others, we show that many patients, especially those with serious disease, behave like hostages in the presence of physicians - unwilling to challenge authority, understating their concerns, requesting less than they desire. How leading providers are delivering value for patients. ![]() The best physicians, we know, reject this advice because it diminishes their humanity and disadvantages their patients, who need more than a highly-qualified body technician, especially when they’re seriously ill. They are warned not to get too close to patients, lest they internalize the suffering and shoulder it themselves. In their medical training, physicians often are taught to maintain a clinical distance and an even temperament. Unhurried medical care may be elusive, but it is practical.īeyond time pressures, the typically unquestioned roles that physicians and patients assume also inhibit relationship-building. We can create more space for active listening. The medical literature increasingly offers potential solutions to the inefficiencies that rob patients of physicians’ time and attention, including delegating lower-expertise tasks to non-physician team members, improving the design of the electronic health system, and greatly reducing the paperwork bureaucracy that adds little or no value. These consequences have clear human and financial costs. All of this serves to diminish the joy of serving patients, thereby contributing to high rates of physician burnout. Clinicians become more likely to provide ineffective or undesired treatment and miss pertinent information that would have altered the treatment plan and are often blind to patients’ lack of understanding. We believe not only that a clinician should share medical decision making with the patient but also that it must occur in the context of an authentic relationship.Ĭompressed medicine has real risks. Overlooking these realities is perilous, both for the patient’s well-being and for efficient delivery of care. It is only through shared knowledge, transmitted in both directions, that physicians and patients can co-create an authentic, viable care plan.Ī doctor’s medical toolbox and supply of best-practice guidelines, ample as they are, do not address a patient’s fears, grief over a diagnosis, practical issues of access to care, or reliability of their social support system. It allows physicians to assume the role of the trusted intermediary who not only provides relevant medical knowledge but also translates it into options in line with patients’ own stated values and priorities. In other words, it might save money in the short term but wastes money over time.Īctively listening to patients conveys respect for their self-knowledge and builds trust. Our experiences - as a critical-care physician whose own critical illness led her to train physicians in relationship-centered communication (Rana Awdish) and as a health services researcher who has interviewed and observed hundreds of patients, doctors, and nurses (Len Berry) - teach us that hurried care incurs hidden costs and offers false economy. ![]() Some health professionals claim that workload and other factors have compressed medical encounters to a point that genuine conversation with patients is no longer possible or practical. Modern medicine’s true healing potential depends on a resource that is being systematically depleted: the time and capacity to truly listen to patients, hear their stories, and learn not only what’s the matter with them but also what matters to them.
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