Doctor-Patient Communication – The Health Care Blog

Learning to Listen

Mar 4, 2018

By ROSS KOPPEL PhD, FACMI

Every physician is taught to listen to patients. Every physician acknowledges it’s an essential skill. Yet, study after study shows physicians interrupt their patients within a few seconds of their patients’ oral presentation of their problem(s). The author, Prof. Terry Hannan, MD, teaches us to shut up for a few minutes. If we do so, medical care will be safer, more efficient, kinder, and patients will help clinicians be better healers.

This book convincingly demonstrates the value of listening to patients; of discovering what is missing or wrong in the chart, of understanding the real etiology, and of the all-powerful value of honest communication. The book is a passionate defense of the physician as a human being who can listen and communicate with patients to help heal and understand. The physician, granted awesome authority and respect by society, is in a unique position to help patients understand and heal themselves in addition to bringing the needed care and science for their benefit. Included here, is knowing when to prevent unneeded care.

All of that said, the reason everyone should read this book–both clinicians and lay readers–is for the short stories of patient’s lives and experiences as they impact their illnesses and the role of healthcare. The stories are inevitably warm, humane, sensitive, and insightful. They give us hope for humans’ ability to help others, or at least to understand and ease their pain.

Each of the stories is this very short book is only a page or three long. Each is personal and poignant. Each gives us hope for medical care and for humanity.

Ross Koppel PhD, FACMI is at the University of Pennsylvania where he is a Senior Fellow at Wharton’s Leonard Davis Institute of Healthcare Economics, at Penn’s Center for Public Health Initiatives and at Penn’s Dept. of Biostatistics, Epidemiology and Informatics. He is also adjunct Professor of Sociology at Penn. rkoppel@sas.upenn.edu

The Patient Explanatory Model

Jun 11, 2013• 7

By Namratha Kandula, MD

In The Birth of the Clinic, Foucault describes the “clinical gaze,” which is when the physician perceives the patient as a body experiencing symptoms, instead of as a person experiencing illness. Even in the era of the biopsyschosocial model, the physician’s perspective is largely through a biomedical lens where biology and behavior cause disease.

In contrast, what I hear from patients is that health and illness are not merely the end results of individual biology and behavior. What people believe and experience when they are ill is usually something far more complex, deeply interconnected with their daily lives. And research shows the way people think about health influences whether they are receptive to health information, willing to change health behaviors or take medications, and even whether or not their health improves. But how are physicians, who are able to spend less and less time with patients, supposed to expand their clinical gaze to include the patient’s health beliefs and perspectives?

Psychiatrist and anthropologist Arthur Kleinman’s theory of explanatory models (EMs) proposes that individuals and groups can have vastly different notions of health and disease. Kleinman proposed that instead of simply asking patients, “Where does it hurt,” the physicians should focus on eliciting the patient’s answers to “Why,” “When,” “How,” and “What Next.”

Kleinman suggests the following questions to learn how your patient sees his or her illness:

1. What do you think caused your problem?

2. Why do you think it started when it did?

3. What do you think your sickness does to you?