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Monday, April 20, 2020

How Becoming a Doctor Made Me a Worse Listener

Adeline Goss
JAMA. 2020;323(11):1041-1042.

Here is an excerpt:

And I hadn’t noticed. Maybe that was because I was still connecting to patients. I still choked up when they cried, felt joy when they rejoiced, felt moved by and grateful for my work, and generally felt good about the care I was providing.

But as I moved through my next days in clinic, I began to notice the unconscious tricks I had developed to maintain a connection under time pressure. A whole set of expressions played out across my face during history taking—nonverbal concern, nonverbal gentleness, nonverbal apology—a time-efficient method of conveying empathy even when I was asking directed questions, controlling the type and volume of information I received, and, at times, interrupting. Sometimes I apologized to patients for my style of interviewing, explaining that I wanted to make sure I understood things clearly so that I could treat them. I apologized because I didn’t like communicating this way. I can’t imagine it felt good to them.

What’s strange is that, at the end of these visits, patients often thanked me for my concern and detail-orientedness. They may have interpreted my questioning as a sign that I was interested. But was I?

Interest is a multilayered concept in medicine. I care about patients, and I am interested in their stories in the sense that they contain the information I need to make the best possible decisions for their care. Interest motivates doctors to take a detailed history, review the chart, and analyze the literature. Interest leads to the correct diagnosis and treatment. Residency rewards this kind of interest. Perhaps as a result, looking around at my co-residents, it’s in abundant supply, even when time is tight.

The info is here.