How it all started…
Several years ago I wrote an op-ed about the physician’s role in patient care and how it has been hijacked by hospital regulations, administrative duties, and insurance company demands. Strangely enough, the COVID-19 pandemic was the first time many doctors had the freedom to completely and actively listen to their patients concerns and questions. That short-lived experience in telehealth inspired my mission with Integrative ENT Health services.
Giving people time to tell their story, the long version, and having a two-way discussion weighing risks and benefits of treatment options is the bedrock of medicine and health. Enjoy!
“Remember when we all started medical school, and one of the first lectures was “How to Take a Patient History”? Some of you rolled eyes, eager to move on to the anatomy, physiology, and pharmacology subjects, but if you listened to your instructor, they told us you could diagnose many illnesses by just listening to the patient’s story. In fact, Nobel Peace Prize laureate Bernard Lown revealed that the medical history provides sufficient information in nearly 75 percent of patient encounters to make the diagnosis (before even performing a physical exam or additional testing).
We also know that sometimes the “chief complaint” is not really what’s bothering the patient. I have had many encounters that started with a complaint of throat tightness but evolve into a conversation about the additional stress and anxiety the patient is currently feeling trying to balance work from home or loss of a job, homeschooling children, caring for an elderly parent; sometimes all at the same time.
Listening is one of the first executive skills learned by children and often where so much parental instruction is spent. It must also be said that active listening is key. Being able to observe a patient’s face as they tell their story can provide clues (and also provide a significant portion of the physical exam). The more physicians develop active listening skills, the more intuition is nurtured as pauses, inflections, and eye movements begin to take on meaning. Active listening is almost impossible when you are simultaneously clicking through an EMR.
As an otolaryngologist, I worried about not being able to visualize the tympanic membrane or the larynx, but I found that by carefully listening to the course of events leading to their concern and how the symptoms evolved I felt much more confident in my assessment. In cases where I felt patients needed to be seen in clinic, I found my suspicion was often confirmed, whether it was head and neck cancer, fungal otitis externa, or temporomandibular joint pain. I am certainly not saying that we no longer need the physical exam but in cases where a pandemic makes access more difficult telemedicine visits have certainly become a legitimate alternative. One could even advocate as we move forward that patients who travel from afar or have difficulty finding transportation could consider using telemedicine when participating in a planned check-up for chronic but stable conditions.
Maybe it is not so much about returning to “normal” as it is about finding a new rhythm and remembering that the most important part of our day simply involves listening.”
