Listening For What Matters
LISTENING FOR WHAT MATTERS: Avoiding Contextual Errors in Health Care. Saul J. Weiner. Alan Schwartz. Oxford University Press.
Image courtesy of Oxford University Press.
In today’s health-care-obsessed culture, Listening For What Matters is an absolute must read. Written by medical doctors Saul Weiner and Alan Schwartz (University of Illinois at Chicago), the treatise states in no uncertain terms that there is one prerequisite necessary for a successful doctor-patient relationship: communication. And while it is ultimately up to the patient to ask the right questions and clearly state why they’ve come seeking medical care, there is concomitant responsibility on the doctor to completely and accurately digest what is being said.
Unfortunately, far too many doctors are bad listeners, jumping in leaps and bounds to the diagnosis and treatment plan before they’ve gathered the material facts and conducted a proper patient interview. In one of the more illuminating passages of Listening For What Matters, the authors recant an exchange where a patient told their doctor they were no longer taking their pills because they’d lost their job and couldn’t afford them, to which the doctor replied: “Sorry to hear that, do you have any allergies?” In another compelling passage, the authors outline a case study in which a doctor ordered more insulin for a patient’s worsening diabetes, neglecting to discover that the patient’s failing eyes were affecting their ability to read the dosing lines on the syringe.
The lesson here is that a physician’s failure to obtain the right information in the right context can bring about fatal consequences. Obviously, doctors are pushed to the limit by their workload as they try to see as many patients as possible to offset shrinking revenue streams and smaller payments from insurance companies. Additionally, many doctors suffer from greatly inflated egos that make them think that they’ve seen just this kind of case a thousand times already, a trap that tempts them to turn off their ears and opt for ‘one size fits all’ treatment plans.
In light of these challenges, Weiner and Schwartz advocate that medical providers come to practice contextualized care – imploring that doctors view each patient as a person with a unique life context and not just a series of medical issues. To this end, the authors have created a system to assess the medical provider’s response to “contextual clues” called “4C” (“Content Coding for the Contextualization of Care”). In sum, this system extends the scientific method all the way to the exam-room interview: Forcing the doctor into a real-time dialogue with the patient, requiring that he listen to every response and then build additional questions based on those responses as the pair move in tandem toward the right diagnosis.
Listening For What Matters (based on a decade of research that saw both actors and actual patients carry hidden audio-recording devices to doctor visits) is truly a unique and important book with a broad-brush reach: Consumers should read it to learn how to better communicate with their healthcare providers, while doctors should immediately review the Weiner-Schwartz “4C” guide-posts to learn how to hear what their patients just said.
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