Every patient tells their story, but are we listening?

Storytelling is an excellent way to learn. In fact, it’s probably the best way to learn. Each patient that comes for medical treatment has their story of signs, symptoms, and circumstances. But often and for certain, when their story is reduced to medical terms, it loses the significance. It is obvious that we are not listening.

One of my longtime friends has a younger brother who is in ICU with serious medical problems requiring the services of a neurosurgeon. Those of us who have experience in medicine usually think that a surgeon is a surgeon. His job is to cut out the offending symptom or disease. After that, they are really not interested in follow-up care or resulting medical issues from their surgical intervention. The surgeon generally does not want to be involved with the family because that is an unnecessary distraction. My friend was posting Facebook updates to her friends on her brother’s condition. She posted after one particularly scary night that the neurosurgeon saw her in the hall outside the ICU and came and gave her a hug. Wow! The comments posted (from medical personnel) all expressed nonbelief.

In the book Every Patient Tells a Story by Lisa Sanders, there are multiple examples of how the patient story is distorted when it is converted to medical terms. We miss all of the social and behavioral flags the patient or family member is sending. We have only to consider the uptick in violence at our hospitals to know this is true. Training for violence in the workplace for hospital employees and staff has been nominal at the best. Most facilities confine it to watching a mandatory video. So how are we surprised when the patient’s son, who has heard from his mom’s physician she has terminal cancer, shows up in her room with a gun?

The second part of the patient’s story is how the diagnosis is delivered. The patient must be a part of the story. It must be understandable or the patient may reject the treatment or go in search of a different result. It must be something the patient can incorporate into daily life. A personal example occurred to my husband after his deep vein thrombosis (DVT) last year. He was not a candidate for the new drugs advertised on television and has to depend on Coumadin/warfarin for his blood thinner. His voluminous instructions for maintenance centered on the stabilized vitamin K in his diet. But no physician knew how to achieve daily stabilized vitamin K. He sought instruction from the internet because none of the specialists or family medicine physicians could help. They absolutely did not know. And why didn’t they know? You would think a hematologist would listen to her patients and find out how they succeeded or failed keeping their lab values consistent. The medical part of this story is only the numbers. If the lab value is too high, you have failed. If the lab value is too low, you have failed. And this story can be repeated for so many other patients with different pathologies.

Suicide rates have escalated significantly among hospitalized patients. The Joint Commission has issued Sentinel Event Report #56 to alert healthcare facilities of this very serious threat. Are the flags missing here as we listen to the patient’s story? How many flags do we have to miss before action is taken? Flags can be everywhere. I am constantly reminded of the student who reported that he was the only male in the emergency room at night and he was regularly called upon to subdue patients. He told me he quit because he was tired of wrestling drug overdoses.

We are slowly recognizing that we need listen with purpose and to respond differently to the patient story. New training is on the horizon and the first wave is Non-violent Crisis Intervention. It includes how to identify behaviors that can lead to a crisis and how to effectively respond to prevent escalation. Verbal and nonverbal techniques for diffusing hostility could prevent violence. We must know how to asses risk levels. We need change and it starts with listening to the patient story.

2 thoughts on “Every patient tells their story, but are we listening?

  1. Quick and unhappy szory: 70+ year old friend, ordinarily healthy, had sweeling and redness and a firm tube like raised are or penile dorsum. VAMC clinic PA and doctor listened to him for about 15 seconds, did “a three foot away medical exam,” Rxd antibiotics and told him zo return in two weeks. After no improvement in the next five days, went to his own family doctor, who also did not examine him, prescribed antifungal cream and referred to a urologist. Two days later, the urologist did no genital exam, (but did a digital rectal prostate exam), gave a different antibiotic, and scheduled him for cystoscopy in two weeks. Thirteen days after symptoms started, he and I (a gynecologist) had coffee, and he told me the story, concluding with “and there is still a firm painful ridge…” I called a cardiothoracic surgeon I know, who confirmed a clot in the dorsal vein from compressive trauma. Could have been treated with TPA acutely. Now he’s on three months of Eliquis, Trental and waited a week for the pain to go away completely. This is not good, folks!

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