Caring For Patients by Listening

I listened to the triage nurse giving instructions to the patient, “Please call the office or Labor and Delivery if you experience bleeding, leakage of fluid, contractions more frequently than four to six times an hour, a headache that doesn’t resolve with acetaminophen, or decreased fetal movement.” I’ve listened to or issued these same instructions thousands of times over the past 20 years. This time I heard them through the phone as they were given to a close family member, hundreds of miles away.

I was instantly irritated and confused. Kendall had come in to Labor and Delivery because she hadn’t felt fetal movement over the past two days. The fetal monitoring was reassuring and she was being cleared for discharge, but the fetus still hadn’t moved spontaneously. After the nurse left, Kendall asked me what she should do now, since she’d already told her nurse and physicians that the fetus wasn’t moving and they had discharged her. How would she know when to come back in?

My mind flashed with Kendall’s obstetrical history: she was 39, her fetus had growth restriction, she had a previous history of a cesarean delivery and was scheduled for a repeat; her pregnancy was full term. I couldn’t overlook the fact that she, like I, was a Black woman.

Did they not hear when she said the fetus still wasn’t moving?

As healthcare professionals, we have a number of algorithms, protocols, and tests that we use to diagnose and manage patients every day. But we frequently underutilize the most powerful tool–listening. There are many approaches that we can all take to improve patient-clinician communication. A few include:

1. Recognize your own unconscious bias.

This self-appraisal takes place long before you step into the exam room. Examine your own assumptions and take steps to overcome them. One example is perspective taking: put yourself in the patient’s shoes–how would you like to be treated if placed in the same situation?

2. Treat each patient with respect and dignity.

Respect is a cornerstone in the patient-clinician relationship. It affords an opportunity for patients and clinicians to communicate as equals.

3. Encourage your patients to voice their concerns.

Talk less, listen more,  and be comfortable with silences. Ask open-ended questions about other things besides medical issues that may have an effect on your patients’ lives.

4. Educate your patients. An educated patient is an engaged patient. 

Part of our responsibility as a clinician is to educate our patients about their medical concerns, disease process, prognosis, and warning signs for exacerbation. A patient who has a good understanding of their condition is also more likely to communicate with their healthcare professional.

Kendall called the nurse back into the room and asked if she could put me on speakerphone. I introduced myself as an obstetrician-gynecologist and asked why Kendall was being discharged when she had many risk factors for a poor obstetrical outcome. I stated that I didn’t understand how she should know to return to the hospital when she hadn’t experienced fetal movement in the past two days. The attending physician came into the room to speak with us and agreed for prolonged fetal monitoring. Kendall was delivered the next morning. A beautiful baby girl. I can’t help but wonder what might have happened, if I hadn’t intervened. Unfortunately, I know what happens. We can do better. We must do better. We should talk less and listen more.

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.