As Medical practitioners, we all deal with several patients/people every day.
How many of us are good listeners? And how many us are pushers, pigeon-holing patients swiftly and sometimes erroneously?
Whys are we given two ears but only one mouth?
What are the warning signs and caveats for a superlative physician / doctor?
We have heard about many patients who have been rushed to the operation room for a disease that they don't have. This is a pity and a lot of suffering. Not being a really exact science, medicine requires that its practitioners listen carefully to their patients to form the appropriate and approximate diagnosis from what they hear even though oftentimes patients are not capable to precisely describe what they have or feel. If on top of that doctors do not listen, the situation becomes hopeless.
Zouheir Maalej
I really appreciate your answer, Zouheir. Besides blunders like enucleation of the wrong eye or amputation of the wrong foot/leg or leaving a pair of scissors or a sponge post-laparatomy, there is a whole lot of other issues that surround patient management, from issues of knowledge, of availability of technological resources, and of experience of the practitioner.
All these factors in combination ensure that no two medical practitioners think alike, or can think alike.
It is vital to understand that:
Medicine is a science of balancing probabilities, and, there are infinite variations in this balancing act for each and every practitioner.
This simple saying is my contribution to all practitioners, to print, cut out, and paste in their consultation chambers to remind them, when dealing with patients, that no two patients can ever be similar, and, that with every patient we undertake to manage, a new set of probabilities arises. No two patients of typhoid fever, rheumatic heart disease, colon cancer, or chronic active hepatitis can ever be exactly or identically or precisely similar. Our approach must necessarily change with every such encounter.
Listening carefully to the patient, like listening to the Ocean and to the Wind, primes the therapist, a secret that only few understand -- Vinod K. GUPTA
I suspect it depends on what's going on. Both are important of course, but if the patient presents with something that is immediately life threatening, then it's probably more important to do something first then listen (or listen simultaneously).
Ronnie,
Your contribution, contrition, and open mindedness is appreciated.
Rafael,
Thank you for participating, and, for putting forth some very pertinent points.
I think you will find the following useful.
I am now in my seventh decade, having worked as a physician for almost 45 years, and, have dealt with around 30 patients per day, say a total of approximately 300,000 patients, very likely more. On some days for 18 years, I would see over 100 patients per day.
I have made some rules of thumb, that you will find very useful.
At the beginning of any session, after introductory formalities are over and the vital statistics are flicked over, I turn to my patients, and ask them how may I help them.
1) I NEVER INTERRUPT THE FIRST 3-5 SENTENCES FROM THE PATIENT< SIMPLY NODDING IN ENCOURAGEMENT for the PATIENT TO CONTINUE or an INAUDIBLE MURMUR or a noncommital Hmm>. IT NEVER TAKES MORE THAN 2 MINUTES. AT THIS TIME I AM HYPER-ATTENTIVE, DESPITE THE NOISES OF THE OUTPATIENT DEPARTMENT.
2) In these 2 minutes, I make out a SINGLE MAJOR PRIMARY COMPLAINT.
3) I NEVER INTERRUPT THE PATIENT FOR THE FIRST 2 MINUTES.
4) IF THE PATIENT SPEAKS LESS and I step in to cover up for the next 2-3 minutes.
5) IF THE PATIENT IS VOLUBLE BEYOND 5 minutes, I GENTLY ESCORT THEM OVER TO THE COUCH TO EXAMINE.
6) IN FOUR DECADES OF MANAGING PATIENTS, I HAVE NEVER FAILED TO DO JUSTICE TO ANT PATIENT.
7) Once on the couch, patients rarely speak further.
8) BEYOND 5 minutes is my time--what I chose to spend with a patient.
9) At 5 minutes per patient, you can see 12-15 patients in 1 hour, and, keep the Insurance company also happy.
10) Do not prescribe more than 2-3 medicines on first visit. If you prescribe more, you do not know what you are treating in the outpatients.
Take it from an old physician: 2 minutes/3 sentences/primary complaint/couch-10 RULES - and you are done.
With in-patients, we all necessarily take longer.
After 5 minutes or so, consultation changes to conversation, and, is generally non-contributory, except in really tough cases. You should approach the inpatient bed with a 10-15 minutes frame of mind (no more), and, go back to your writing desk/office/workstation. If you spend more than 10 minutes, you have not been listening well. The physical examination of a comatose patient/GBS/complex multi-valve cardiac disorder can be completed in 10 minutes, if your mind knows what is to be sought.
With intensivists/lab/ECG/X-ray/cannula/ infusion order/specialist's referral -- write in 5 minutes and move on. Come back again to the patient later.
Psychiatrists have to listen more often to heart-pouring complaints ---that is their history + examination.
Encourage those who speak less / curb those who speak more.
But, all the time, LISTEN.
Try it. It really works.
I added a rare case of endometriosis externa of the rectosigmoid wall to my threads today.
I advise all physicians/neurologists/gastroenterologists/general practitioners to read and benefit, and, continue to learn the value of and to develop the ESP (extrasensory perception) of MEDICINE.
- Badges
- Science topic
- Similar topics
- Engineering
- Materials Engineering
- Powders