Doctors can improve how they communicate with their patients. But, sometimes your doctor should be saying nothing at all. That's because he or she should be listening.
When a patient is talking, studies suggest that doctors frequently interrupt them within minutes or even seconds. That's a shame.
Doctors can learn a lot by listening. Listening can have a therapeutic effect, according to research on the "placebo effect." Some patients may feel better after getting a placebo treatment -- an inactive pill or other treatment is taken with the expectation that it will help. They may even show improvement in a condition, such as a lower blood pressure. At least some of the placebo effect seems to be related to the benefit of discussing health concerns with an interested, empathetic listener.
I've learned a lot by talking less and listening more. But some of the most powerful lessons I've learned revolve around patients' resourcefulness, initiative and powers of observation.
Here are just a few of the things my patients have taught me.
- Everyone is different. Just because the textbooks or medical journals don't list a particular side effect for a medication doesn't mean it can't happen to you. For example, sleepiness is not listed as a prominent side effect of acetaminophen (as in Tylenol and many other products). But several patients have complained to me about this as a side effect. That makes it hard to dismiss!
- Changing the time of day a medication is taken can reduce side effects. Low doses of methotrexate — taken just once a week — are commonly prescribed for rheumatoid arthritis, psoriasis and many other conditions. However, nausea can be a bothersome side effect to taking the weekly dose. Several of my patients have noticed that if they take the drug at night, they don't have (or notice) the nausea. I've begun to suggest this to other patients.
- Owning a dog can be good for you. This certainly wasn't something I learned in medical school. But, over and over, I hear it from patients. If you have to walk your dog, you have to get up, go out and get moving. Studies have documented other benefits of pet ownership. Pets have a calming effect and pet ownership has been linked to lowering blood pressure.
- Alcohol can be good for you. Many of my patients noticed that drinking alcohol may help Raynaud's phenomenon. Raynaud's phenomenon is a common condition in which the blood vessels in the fingers (or elsewhere) temporarily constrict in response to cold. This causes pain, numbness and a pale or blue discoloration. According to some of my patients, just half a glass of wine reduces their symptoms. It makes sense, actually, because alcohol tends to open up blood vessels. This could counteract the blood-vessel constriction characteristic of Raynaud's phenomenon. While there is research suggesting that moderate red wine consumption is associated with a lower risk of having Raynaud's phenomenon among middle aged adults, I can find nothing in the medical literature confirming my Raynaud's patients' observations that having a drink will reduce their symptoms.
- There are many ways to keep your skin soft. One of my patients with scleroderma taught me that "Bag Balm" can help soften the thickened skin characteristic of the disease. Scleroderma is a rare condition. The cause is unknown. It creates excessive scar tissue throughout the body, especially in the lungs and skin. The "usual" moisturizers available at drug stores don't always help soften the skin. Bag Balm is an ointment initially marketed as a treatment for irritated cows' udders. While it's still used for horses, cows and other domestic animals, it can be helpful for humans as well. I've recently learned it's been used to soothe skin after getting a tattoo.
- Medical care is a partnership. Perhaps the biggest thing I've learned from my patients concerns the role I play as their doctor. Many of my role models practiced medicine by telling patients what to do. But as I completed my training, I quickly realized that negotiation and compromise are key to providing good medical care. My job is to provide as much good information and advice as I can while focusing on the patient's best interests. But the patient is the one who makes the decisions. After seeing me and hearing my recommendations, they may choose a different approach. And that's fine for adults who are able to make a well-reasoned choice between options. My patients have taught me that I can't make decisions for them — each individual must balance the risks and benefits of one treatment against another treatment (or no treatment) based on the best available information.
I've learned a lot from my patients. But it's not always clear what I should do with what I've learned. For example, should I recommend my patients with Raynaud's phenomenon drink alcohol? Since it's not been well-studied, it may not reliably work, despite what a few of my patients say. And clearly there are risks associated with excessive alcohol intake.
Even so, I believe there is enormous value to my patients' stories and experiences. Sometimes it's information that can help other patients. And even when the information is not something I think will apply to other patients, listening has value in itself.
In my view, how your doctor is listening is often at least as important as what your doctor is saying.
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Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program