Author: Danielle Ofri
Surgeons more than physicians and physicians more than nurses are convinced that surgery or prescription is the only way to heal; everything else is talking. After all, in universities, it is taught that only technical skills count. We prepare students to read a CT scan, interpret an ECG, and evaluate a set of blood tests, but they do not learn how to deal with patients facing a serious illness or the fear of dying.
The conceptual drift of evidence-based medicine (which in its initial assumptions presupposed the integration of the search for the best scientific evidence with clinical experience and the patient’s values) has reinforced this view. In addition, the vast majority of physician updating (funded primarily by manufacturers of drugs, prosthetics, and medical equipment) supports the notion that prescribing a new medication or test makes you up to date and competent.
Danielle Ofri, an internist at Bellevue Hospital in New York City (and also a writer, editor, and cello player), demonstrates in her book, “What the Patient Says, What the Doctor Hears,” how good communication can crucially affect the effectiveness of any treatment. She does so by telling stories of satisfying and frustrating relationships established between doctors and patients. “As medicine becomes more complicated,” Ofri writes, “with more multifaceted and complex diseases, the gap between what patients say and what physicians hear, and vice versa, becomes increasingly pronounced. This is the main reason the patient, with his personal, family, and social history, with his expectations, desires, fears, and values, feels excluded from managing his disease. His health is played only in the choice between drug A and drug B. In recent decades, many voices have been raised to call the attention of doctors to recover the sense and value of listening to the patient, using generic arguments.
This book contains data from many studies, which show how the definition of the diagnosis and treatment is better when the patient has been able to express himself and how the time devoted to listening is not wasted, but a real investment: fewer mistakes are made, unnecessary drugs and tests are not prescribed. Ofri is aware that the issue of communication is delicate and does not only concern skills to be learned but involves emotional aspects brought into play between two human beings who confront each other. With a series of emblematic, complex, masterfully written clinical stories, it is told how much of the dissatisfaction and failures depend on the mutual difficulty in understanding each other. The author, as a musician, advises us to sharpen our hearing to understand what is wrong and to offer the empathy that is essential for healing. She reiterates, “the greatest fear of patients is not being heard by doctors and therefore not receiving the care they need.”
Book review wrote by Marco Bobbio