(I wrote this piece for a local medical journal, I thought I'd share it here too)
The teacher who sticks rigidly to a text book and rarely
entertains deviation from the lesson plan isn’t the one that inspires
students. The stalwart disciplinarian who
refuses to hear questions rarely gains the favor of subordinates. We want to inspire others to take
responsibility for themselves, and that inspiration comes mostly from understanding
and intuition. Paula Denton wrote a piece for the Virginia Journal of Education called The Power of Listening. It was written for teachers, but its lessons
are easy to apply to my clinic:
“To be known and understood is a basic human need. When we fulfill that need for students (or patients), they feel a sense of belonging and significance… “
Which brings me to my practice of massage therapy. Patients love feeling physically better and
having their needs anticipated, but above everything else, they want to be
listened to. That is often what brought them to me in the first place.
In his insightful TED talk, Abraham Verghese MD., Professor of Medicine and Senior Associate Chair
for the Theory and Practice of Medicine at Stanford University, talks about the
most frequent complaint he hears about doctors,
“it is amazing how often you hear, "(S)he never touched me!" or, ". . . never laid a hand on me!" or "never looked at me" or "never listened" or "was too busy looking at the computer screen.""
His main point is that
when doctors spend time trying to create a virtual model of the patient, they
forget to see the actual person sitting in the room. Although that doesn’t happen in my field, the opposite problem
occurs regularly. Patients are brought
into a room without a proper interview and given a generic massage routine
which addresses none of their specific complaints.
As with many complementary and alternative therapies, massage
therapists spend the majority of their time with a patient one-on-one. We are in a wonderful position to help
people, and have the time necessary to listen carefully. People often seek alternative health
practices simply because they want to be treated this way. When I see a patient for the first time, the
interview and intake procedure can take 20 minutes or longer, because I listen to
everything they have to say about their pain and ask all the necessary
questions to understand their goals. Time
to express their complaints with my undivided attention gets nearly as many
positive comments as the massage gets.
Listening isn’t easy.
There is a misconception that if you sit quietly while
someone speaks, you have met all the requirements for listening.
Being present, with open ears, is just the beginning.
When someone speaks to us they are trying to tell us many
things. Besides the basic message in
the words themselves, there is subtext in why they chose the words they use,
the expressions both in the face and the tone of voice, and body posture. Most of these messages are lost on the
active listener. Really listening to
someone for more than a few minutes is much more challenging than it sounds. Most of the time, in conversation our brain
is busy anticipating the next chance to speak.
When with a patient, we want simple clear answers to tick boxes either on
a chart or in our minds. Our own
thoughts, agenda, point of view, and expectations can seep in and drown out
hearing the whole message.
In a busy environment--with computer whirring, charts with
empty spaces, missed calls and texts, anticipation of several more appointments
today--focusing on the task of eye-contact and evaluation of words as they are
being actively spoken can seem next to impossible. To combat this there is no computer in my treatment room, there
is also no phone, and virtually no other distractions from the patient. I don’t even write down much of what is said
until after the interview is over, just quick notes to keep track. Even with all these modifications, I still
have to actively quiet my mind to avoid categorizing problems prematurely. My scope is fairly small, and even so, a
missed detail can be the difference between an effective intervention, and a
null result.
More importantly, I don’t want to be another example in a
long line of, “I saw so-and-so and he didn’t even listen to me.” Most of my patients have these stories in
common. It is not unusual for a primary
care physician to send a patient home having never touched them and barely
talked to them, usually recommending large doses of ibuprofen or naproxen, if
anything is recommended at all. If they
come back, they are sent to a physical therapist who doesn’t touch them or
listen to them before sending them off to do painful exercises with an
assistant who urges them to ignore the pain and stick with it. When results from this are less than
stellar, should anyone be surprised?
Anti-inflammatory medicine may have been the right call, the
exercises may have been exactly the right ones, but the patient didn’t feel
satisfied with encounter with his/her clinician, so compliance is minimal. It is human nature to take the advice of
someone we like or respect. A 2010
Harvard Medical School study showed that about 20 percent of first-time
prescriptions are never filled. That
number drops even lower when we look at advice given without a written
script. OTC medicines aren’t taken
seriously and take home exercises, in my experience, are very rarely done
properly.
It is admittedly easier to get patients to stick to a massage regiment. Despite the expense, massage is pleasant, feels significant and specific when done properly, and gets quick short-term results. During that time, if I can convince them to dust off the PT’s orders, or follow the regiment their doctor recommended, the results only improve.
