the missing piece

 

If you are a health care provider or therapist in any discipline, you may find yourself frustrated from time to time when a patient does not respond to treatment. You find yourself questioning the diagnosis. You ask the patient about his symptoms over and over again, re-examine him, and order additional tests without getting anywhere. Something doesn’t add up. There must be a missing piece. Too often, the patient is labelled as uncooperative, difficult, or mentally ill...when you may not have heard the patient’s whole story.

“The simple yet complex act of listening is,
in and of itself,
a clinical intervention.
Listening constitutes the very heart and soul
of the clinical encounter.”

~Mary T. Shannon~

Some days there just isn’t time to explore the details of his illness with every patient. Perhaps you’re running behind schedule, or an emergency interrupts you. Some patients can’t bear to disclose the sorrow or fear or shame that underlies their symptoms. Some remain in denial for reasons we don’t understand.

Rita Charon, MD pioneered the practice of “narrative medicine” almost twenty years ago as a path to help clinicians uncover the missing piece in their patients’ histories. It trains the healer to recognize the fact that the problem exists, and then to elicit the patient’s untold story—to listen, receive, interpret and apply what the patient reveals.
 

 

This is how she begins with a new patient. She simply invites the patient to “tell me what you think I should know about your situation.” Then she listens to the patient without interrupting, clarifying, correcting, or taking notes. Instead, she focuses her attention on what is revealed and how it is communicated…paying attention to the patient’s posture and gestures, images and metaphors, facial expressions, and the characters who play a role in the story. This approach may take more time at the beginning but, in the long haul, it saves us from revisiting the history again and again, from ordering unnecessary tests, and from wasting time and resources on ineffective interventions because of what we have missed.

“I am, by calling,
a dealer in words;
and words are, of course,
the most powerful drugs used by mankind.”
~Rudyard Kipling~

When we reach into our patients’ cholesterol-laden hearts to understand why they are poisoning themselves with food, we need to know more than what they putting into their mouths. When we let the patient talk, we may discover that the real reason for this one’s fatigue or that one’s intractable headache is end-stage disappointment or anger or shame that has festered for years.

Only then we can help them heal.

"Histories must be received,

not taken."

~Sir Richard Bayliss~

jan