American College of Physicians: Internal Medicine — Doctors for Adults ®

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When listening, not action, is the best medicine

From the September 1999 ACP-ASIM Observer, copyright 1999 by the American College of Physicians-American Society of Internal Medicine.

By Arthur D. Silk, ACP-ASIM Member

When I started out in practice years ago, I firmly believed that to earn my fee, I had to do something for the patient. Unless I gave a shot, stitched a wound or at least wrote a prescription, I felt that I had not earned my fee. Only after many years of practice did I realize what psychiatrists and the clergy have always understood: Sometimes the role of listener is the most important one you can play.

When my 4-year-old granddaughter takes a tumble, floods of tears can miraculously dry up as soon as her mother hugs her. Though the law has all but tabooed such human touches in the medical profession, we are still allowed to lend an ear. Often, patients come to the office with the realization that I am not going to do very much but hope that I am going to simply listen.

As my patients have been telling me in their own way for years, an informed, sympathetic authority figure can serve in loco parentis. In many cases, a doctor can give much comfort to distressed patients by simply expressing a genuine concern and giving them an opportunity to express their feelings.

Years ago, when I saw an article in a journal reporting that doctors let their patients speak for an average of 11 seconds before interrupting, I scoffed. Soon, however, it dawned on me that I was guilty of the same sin. Often, when a patient starts to talk, I know what he's going to say because he's covered the same ground on previous visits. In the rush of a hectic schedule, I tend to forget that allowing him to say it again in his own words and in his own time is part of the healing process. Though it's hard to break old habits, I now try to hold my tongue.

In my practice, I regularly see a 73-year-old ex-smoker with severe emphysema who, despite inhalants, cortisone and portable oxygen, is always short of breath. She is not a candidate for lung reduction surgery. During her visits, I put my stethoscope on her chest, take her blood pressure and look for cyanosis. But mostly I just listen to her tell me how she feels. It seems to help.

My experience has been similar with patients suffering from irritable bowel syndrome, a condition that can persist into middle or even old age. Having seen scores of patients unable to find relief with antispasmodics, tricyclics, pain killers or laxatives, I now realize that they come to my office not because they expect a miracle but because they apparently get some relief just from my listening to them telling me how miserable they feel.

Sir William Osler once wrote, "Listen to the patient and he will tell you his diagnosis." I would add the following: "Listen to the patient and you will help him feel better." This being the case, you might think that giving your time and attention to what a patient has to say would merit a listing in ICD-9. Don't bother looking. "Listening" is lost between liniment and listeria, which surely says something about the humanity of bureaucrats.

Dr. Silk is an internist in Garden Grove, Calif.

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