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Learn to listen to patient stories


The pandemic has been a time of painful social isolation for many. Few places can be as secluded as hospitals, where patients are surrounded by strangers, subjected to invasive tests, and attached to an assortment of beeps and gurgles.

How to make the experience of receiving medical care more welcoming? Some say that a sympathetic ear can help patients who are under the stress of a hospital stay to heal.

“It’s even more important now, when we can’t always see or touch patients’ faces, to really hear their stories,” said Dr. Antoinette Rose, emergency care physician in Mountain View, Calif. , who now works with many patients with Covid.

“This pandemic has forced many caregivers to come to terms with the human stories that are unfolding. They do not have the choice. They become the “family” at the bedside, ”said Dr. Andre Lijoi, medical director of York Hospital in Pennsylvania. Doctors, nurses and others who help care for patients “need time to slow down, to breathe, to listen.”

The two doctors find their inspiration in narrative medicine, a discipline that guides doctors in the art of listening deeply to those who ask them for help. Narrative medicine is now taught in one form or another in about 80% of medical schools in the United States. Students are trained in “sensitive interviewing techniques” and the art of “radical listening” as a means of improving interactions between physicians and their patients.

“As physicians, we need to ask those who come to us, ‘Tell me about yourself,’ said Dr. Rita Charon, who founded Columbia University’s pioneering narrative medicine program in 2000.“ We have fallen out of this habit because we think we know the questions to ask. We have a checklist of symptom questions. But there is a real person in front of us who is not just a set of symptoms.

Columbia currently offers online training for medical students like Fletcher Bell, who says the course is helping transform the way he sees his future role as a healer. As part of his training in storytelling medicine, Mr. Bell kept practically in touch with a woman who was being treated for ovarian cancer, a sharing experience he described as both heartbreaking and beautiful.

“Just listening to people’s stories can be therapeutic,” Bell observed. “If there’s fluid in the lungs, you drain it. If there is a story in the heart, it is important to spread it as well. It is also a medical intervention, but not an easily quantifiable intervention. “

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

The typical visit to the doctor now lasts 13 to 16 minutes, which is usually all insurance companies will pay. A 2018 study published in the Journal of General Internal Medicine found that the majority of doctors at the prestigious Mayo Clinic didn’t even ask people the purpose of their visit and frequently interrupted patients when they talked about themselves.

But this fast food approach to medicine sacrifices something essential, says Dr. Deepu Gowda, assistant dean of medical education at the Kaiser-Permanente School of Medicine in Pasadena, Calif., Who was trained by Dr. Charon in Columbia.

Dr. Gowda remembers an elderly patient he saw during his residency who suffered from severe arthritis and who he felt was angry and frustrated. He came to dread his visits to the office. Then he began to ask the woman questions and listened with interest to her personal story unfolding. He became so intrigued by her life story that he asked her permission to take her picture outside the hospital, which she granted.

Dr Gowda was particularly struck by a photo of his patient, cane in hand, clinging to the railing of his apartment without an elevator. “This image represented to me his daily struggles,” he said. “I gave him a copy. It was a physical representation of how I cared about who she was as a person. Her pain didn’t go away, but there was a lightness and laughter in those subsequent visits that hadn’t existed before. There was a kind of healing that took place in that simple human recognition.

While few practicing physicians have the leisure to photograph their patients outside of the clinic, or to delve deeply into their life history, “people find out” when the physician expresses genuine interest in them, said Dr Gowda. . They trust such a doctor more, motivating themselves to follow their instructions and return for follow-up visits, he said.

Some hospitals have started to conduct preliminary interviews with patients before the start of clinical work in order to get to know them better.

Thor Ringler, a family therapist, started the “My Life, My Story” program at the William S. Middleton Memorial Veterans Hospital in Madison, Wisconsin, in 2013. Professional writers are hired to interview veterans – by phone and video conference from the start of the pandemic – and write a short biography that will be added to their medical records and read by their attending physician.

“My goal was to provide vets with a way to have their voices heard in a large bureaucratic system where they don’t always feel heard,” Ringler said.

The program has spread to 60 VA hospitals, including Boston, where more than 800 Veterans’ Stories have been compiled over the past three years. Jay Barrett, nurse manager at the VA Boston Healthcare System, said these biographies often provide critical information that can help guide treatment.

“Unless you have access to the patient’s story,” Ms. Barrett said, “health care providers don’t understand that this is a mother looking after six children or not either doesn’t have the resources to pay for the drugs, or it’s a veteran with severe trauma who needs to be dealt with before even talking about how to manage the pain.

Dr Lewis Mehl-Madrona, a family physician who teaches at the University of New England in Biddeford, Maine, studied veterans who were undergoing pain treatment. Those who were asked to share their life stories felt less chronic pain and rated the relationship with their doctor higher than those who did not. Doctors who solicited the articles also reported greater job satisfaction and suffered less emotional exhaustion, which became a particularly worrying issue during the Covid pandemic.

The time demands of healthcare workers have never been greater. But advocates of narrative medicine say it only takes a few moments to forge an authentic human connection, even when communication takes place online, as is often the case today. Dr Mehl-Madrona argues that remote video conferencing platforms like Zoom can actually make it even easier to track vulnerable people and solicit their stories.

Derek McCracken, a professor at Columbia University who has helped develop training protocols for the use of storytelling techniques in telehealth, agrees. “Telehealth technology can be a bridge,” he said, “because it’s an equalizer, forcing both parties to slow down the conversation, be vulnerable and listen carefully.”

The critical point for Dr Mehl-Madrona is that when people are asked to talk about themselves – whether it happens in person or on screen – they “don’t just turn themselves over to the doctor to get it. be repaired there. They are actively engaged in their own healing. “

“Doctors can be replaced by computers or by nurses if they think their only role is just to prescribe drugs,” he added. “If we want to avoid the plight of the Dodo bird, then 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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