Why you no risten?

Some friends of mine - we’ll call them Bob and Jane - suffer from time to time, as I am sure all people do, from a bit of a communication breakdown. When Bob feels that Jane isn’t listening he will say to her “why you no risten?” No – it’s not typo. It’s said in a mock far Eastern accent (think Mickey Rooney in Breakfast at Tiffany’s). I think it’s an old Benny Hill catchphrase. It’s possibly in poor taste, but it’s meant in a light-hearted way and helps defuse the situation. It’s amazing how wound up people get if they feel that they aren’t being listened to.

Another friend recently had cause to make use of the NHS. Over all he felt he had been well looked after, but he felt that no one really listened to him. Whenever he tried to explain his symptoms he got cut off in mid flow. He felt that the various people involved would snatch at just one symptom and base everything they did on that. His problems still haven’t been solved, and he feels that is down to the simple inability or disinclination of doctors to just listen for five minutes.

Dr Mark Porter, on an edition of Radio Four's Case Notes in 2004, discussed an idea where a practice nurse would listen to the patient, then summarise for the GP who would spend 3 minutes prescribing and that was the end of the consultation. At the time I thought it was a good idea. Waiting lists down – hurrah! Someone to listen – hurrah! And a nice prescription at the end of it – hurrah! But my reservation is that it makes it look as though listening is one of those light weight things – not “real medicine” – that it’s safe to let nurses do and that doctors are too busy to do. Really? Doctors are too busy to speak to patients? Do they really want to be automated dispensing machines – nurse summary of patient issues in, prescription out? And what about the Chinese whispers effect that comes when you put a third person between the doctor and the patient?

I started to write this piece a while ago and it seemed to be turning into a rant with nowhere to go. I was going to mention the many books on communication skills we have in the library, and the annoying piece on the BBC health website about talking to your GP – annoying because the onus is put entirely on the patient to ask the right questions and to sympathise with the poor GP.

I’m dusting off this piece again today because I’ve read an article in the Times about a book written by Dr Jerome Groopman. Dr Groopman says - well, that doctors just don’t listen. He says there is a tendency to pounce on the first symptom offered and to fail to put that into context. He says that doctors make decisions without thinking how or why they are making those decisions. They don’t listen to the whole story. He also talks about fitting the facts to the theory by ignoring any symptoms that don’t fit in with the diagnosis you want to make.

Interestingly D Groopman does not mention narrative medicine by name. He says that “When [he] started out in medicine, the doctor’s focus was on the bond between himself and the patient, with the latter’s life story being as important as his or her reported illness.” To my mind that is a concise and simple description of the concept of narrative medicine.

As ever on this blog I have no solutions for you. This is (I hope) a starting point for discussion, reflection and reading. Start with a brief introduction to Narrative medicine plus further reading from Alaska. Consider the following books (available in the library) on narrative medicine: Launer's Narrative based primary care, and two titles by Trisha Greehalgh - Narrative based medicine and Narrative research in health and illness.

We have too many books on communication skills to list them all here. You'll find them on the shelves at W62.