Listening

Today I saw a patient with epilepsy. She came to me from another neurologist. Her and her husband were very upset with his care. He has a good reputation. I've met him twice. I've seen a handful of his patients. This is the third time that we've met. Today they complained about the care they had again. They've spent a fair amount of time on that issue at each of the visits. I think they felt betrayed. Today, she said the key words: "He didn't listen." When we don't listen to our patients they feel betrayed. They feel that we don't care. Care is what they really come for. They come for that even more than anything else. We are, after all, "Health CARE providers." We provide care. Not listening is probably one of the biggest mistakes that we make as doctors. It causes failures in diagnosis. It causes loss of faith. It causes anger. I try to listen.
Yesterday I sent a letter of dismissal to a patient, telling her that I can no longer be her physician. It is a woman with severe, disabling chronic pain. I never could figure out what was wrong with her. Nothing really helped her very much. I sent her for a second opinion at a fancy tertiary care institution, but they didn't really figure out what was wrong with her, either. Finally, we ended up with her on narcotics. Even that didn't seem to help that much. It's been a very difficult case. I just haven't been able to figure things out. Last week, she could hardly walk around the office or get up on the exam table. I watched her out the window. When she got in her car, she was able to bend over easily and turn the steering wheel while holding the phone between her shoulder and ear. The pharmacist called me to ask about her prescription. She told me that my patient was walking around perfectly normally and standing there very comfortably. So I had been listening to the patient when I shouldn't have been. I should have been listening to something else. Something that would have told me that things didn't add up.
Tonight, when I got home, the plants out back wanted water. The hibiscus bonsai were drooping. That's how you know they want water. So I listened to them and went out there with the hose. I found a baby eggplant growing. It's about two inches now. It's quite a miracle when an eggplant grows. I try to listen to the plants, but they're hard to understand sometimes. It's kind of like people. All in all, though, I think it's easier to listen to the plants than the people.