Intima review of “What Patients Say, What Doctors Hear”

byNelly Edmondson
Intima–A Journal of Narrative Medicine

In her book What Patients Say, What Doctors Hear, Danielle Ofri, MD, takes a deep dive into the ways doctors and patients miscommunicate or fail to communicate, and the problems that result.

In a time when technology seems to outpace humanity, many in the medical profession are trying to bridge the communication gap. One indicator is the growing recognition of the importance of stories – personal narratives of patients and doctors – as a key component of successful medical practice. This book testifies to the work one doctor has done to better understand herself, her patients and her profession. Drawing on research, her own experiences and those of her patients, Dr. Ofri dissects the communication missteps that can impede effective care.

In one memorable instance, she tells readers about the time one of her patients literally collapsed in front of her and needed to be rushed to the ICU, and how that forced her to rethink her perception of him as “pushy” and “entitled.”

 â€œFor all his annoying mannerisms and pushiness, Mr. Amadou was fundamentally trying to say, “Help me.” Deep down…he was terrified that his heart could give out at any moment… Seen in this light, his relentlessness was understandable – his life hung in the balance – so he could never take no for an answer.”

In another case, Dr. Ofri questions her clinical acumen after a 37-year-old woman comes to her with a fungal infection on her scalp and the doctor misses clues to a deeper problem. Dr. Ofri dispenses a prescription, performs a physical exam, finds nothing amiss and discounts the patient’s offhand mention of vague discomfort as “the routine aches and pains of life.”

Hand on doorknob, her patient turns back and says, “Can I ask you a question?”

 â€œSure,” I said, putting down my pen. Ms. Padilla paused, and her voice grew more tentative. “Do you think…About the parts that hurt me: my knee, my shoulder, my head, my stomach…Do you think it’s at all important that these are the same spots where my boyfriend shot me with a dart gun?”

After this incident, Dr. Ofri berates herself. “Why wasn’t my radar alert to domestic violence? Why didn’t I catch the tautness in her smile? Why hadn’t I keyed into the withdrawn demeanor coupled with the seemingly random symptoms?”

Certainly, this doctor is asking a lot of herself. But she believes that she and her colleagues can do a great deal of good by following some simple guidelines. Among others, these include asking patients more open-ended questions, eliciting patients’ concerns, inquiring about the patient’s life beyond the illness, and involving the patient when choosing a treatment plan. “Nearly any attention paid to these skills,” she writes, “easily improves communication.”

This is a book that patients and doctors alike will find both illuminating and instructive