I met Darlene during my internship. She scheduled my continuity clinic patients, and we became fast friends. I loved her sense of humor and fierce protectiveness of those with whom she worked. Our roles changed through the years, but our relationship remained a constant. She was one of my favorite people to see in the hallways and always put a smile on my face.
Two summers ago, Darlene was admitted to my service. I reviewed her data with my resident team and pulled up her CT scan. What I saw made me want to cry – a large pancreatic mass. I had to give her the news. We talked and listened, and we both shed some tears. We formulated a plan to confirm the diagnosis of pancreatic cancer and move forward. I saw Darlene periodically over the next several months. We chatted and I listened for clues to help us guide her care.
In mid-October of that year, I visited Darlene during one of her inpatient stays and recognized she was nearing the end. We talked, probably for about an hour. She finally asked me if she was dying. I took a long breath and told her she was. Darlene was silent for a while, and I forced myself to allow that silence to breathe. When she began talking again, we discussed her next steps – essentially, how she wanted to die. I did my best to listen and remember. She passed the next day, comfortable and surrounded by work colleagues and family. She joined her beloved husband Jim, who also had recently passed away.
I share this story to illustrate the importance of listening. Had we not listened, Darlene’s passing may have been very different. Those who loved her would have very different memories of her final hours.
We have all heard of the 1984 study demonstrating that patients were interrupted by their physician within the first 18 seconds of beginning their story (Ann. Intern. Med. 1984;101:692-6). Each of us has likely made a mental note to listen more – to our patients, our partners, and our friends. Sadly, we have all probably struggled to make that a consistent reality.
Listening is not easy. It is hard work and it takes time, but it is essential in developing relationships. Physicians and providers are constantly pressured to move quickly and efficiently. Being asked to take the time to listen can be annoying, because we feel listening will slow us down. Taking that extra time, though, gets us to our destination more quickly. It provides us with the information we need to make the proper diagnosis and confirm the correct treatment choice for a patient’s desires and beliefs. It facilitates understanding and solving problems with our colleagues. It shows us a different point of view. Listening benefits everyone.
I challenge each of us to take an extra moment to listen – it is time.
"One friend, one person who is truly understanding, who takes the trouble to listen to us as we consider a problem, can change our whole outlook on the world." –Dr. E.H. Mayo
Dr. Michael Pistoria is chief of hospital medicine at Coordinated Health in Bethlehem, Pa. He believes that best care is always personal.