If you ask GP Fiona Reilly what the key to good healthcare is, her first answer might be a little unexpected.
“The fundamental building block of medicine is stories,” Dr Reilly, a senior paediatric emergency physician, tells ABC RN’s Life Matters.
“The care of the sick unfolds in stories.”
But Dr Reilly says doctors often don’t allow patients to share these stories, which could include the feelings, concerns and experiences they bring into a medical consultation that impact their medical interactions.
She points to a 2019 US study published in the Journal of General Internal Medicine that looked into the time it takes before a doctor interrupts a patient for the first time.
“It’s devastatingly bad. It’s 11 seconds,” she says.
But when they are given that space, Dr Reilly says a patient’s experience is vastly different — and so is the feeling they walk away with.
A worried mother’s story
When patients visit a doctor they bring “complex and sometimes quite ambiguous problems”, Dr Reilly says.
And these aren’t always answered by a purely scientific approach to medicine.
Dr Reilly believes it’s essential that health professionals also have skills in listening deeply to their patients.
Without those skills, they’ll miss valuable information and a valuable opportunity to build trust and connect with their patients.
For example, Dr Reilly recalls meeting a family at her paediatric emergency department several years ago.
Their three-year-old daughter had a fever and doctors treating her believed it was likely a viral illness and that the child wasn’t too unwell.
But the family remained highly anxious about the child’s illness. It led the doctors to do a number of extra tests — including a urine test, chest X-ray and blood test — which were “building up in terms of the complexity and cost, both to the patient and to the system”, Dr Reilly says.
The tests returned as normal, but the family’s concern was undiminished.
As a result, “the doctors began to second guess themselves”, wondering if they were missing something, Dr Riley says. She was brought in to give a second opinion.
The first thing she did was speak with the child’s mother, who was on the verge of tears.
“What transpired was a really important story,” Dr Reilly says.
The mother explained that years earlier, when she was 34 weeks pregnant, she sensed something was not right with her pregnancy and sought medical care. At the hospital, she’d been reassured that everything was okay after a number of tests. But, tragically, after she returned home the baby had died.
“It was as the mother told me this story that I understood how that story connected to the story of why she was so worried about this child today,” Dr Reilly says.
It meant all the doctors could approach the family with a greater understanding of their concern and a better chance of managing it.
Dr Riley says the more patients feel listened to, the more likely they are to have closer and more productive relationships with their medical providers.
“When patients come to me, they come with a story about their illness, that narrative of their illness experience,” she says.
“That storyteller has power.”
An empathy deficit
Dr Reilly practices and teaches narrative medicine, a method of consultation in which doctors hear their patients’ experiences as a story.
Listening and empathy are both integral to the practice.
“Unless we really encourage good, deep attentive listening, we’re going to miss valuable information and a valuable opportunity to build trust and connect with our patients,” she says.
A different approach might’ve changed outcomes for Life Matters listener Amy*, who explained how her father was told by his doctors that his illness had become terminal.
“The way that information was delivered was so cold, blunt and devoid of empathy, that it made my dad feel completely hopeless and disempowered — so much so that he refused to tell us what the doctor had said to him about the amount of time he had left,” Amy says.
“And this meant we couldn’t actually support him through this last crucial period in his life.”
Amy’s story is unlikely to be an isolated one.
“Research shows very clearly that there’s a decline in empathy through the years of medical school,” Dr Reilly says.
“Medical school is currently structured [in a way that] is extremely intense. It’s very competitive [and] there’s a very high study load.
“It actually has the effect of squeezing empathy out of medical students. So they come in with a lot of empathy and by the time they leave medical school as doctors, they have much less than they started with.”
Dr Reilly believes narrative medicine is “a very neat, practical and efficient way of bringing empathy back in”.
Skills outside the box
Award-winning author Tony Birch regularly teaches creative writing. Now he’s also teaching in the University of Melbourne’s narrative medicine course.
In an Australian-first, the course is offered to medical students as a four-week elective.
Dr Birch says medical students are asked to respond through writing exercises to a series of provocations or prompts. Then, in a supported, guided environment, the students share and discuss their work.
“When you’re writing creatively, and when you’re responding to creative work, you are listening [and] you are really engaging with the sense of, where’s the emotion in this? Where is the empathy in this?” Dr Birch says.
He’s found it fascinating to observe medical students taking up the challenge.
“What I found is that, as I hoped and expected, they were very subtle, they are very nuanced in talking about human relationships. So then we’re able to extrapolate from that [exercise] discussions about listening and about caring around other people.
“I remember saying at the end of the first groups that I [taught], I hope that one day I get to be treated by one of you because I think you’ll make remarkable doctors.”
Empathy doesn’t need to take more time
Dr Reilly says it’s a commonly held misconception that “practising good listening in a medical context takes extra time”.
But if patients are given the space and time to speak, she says the average time it takes them to tell their story — “the story that’s important to them” — and explain what they need from the interaction with a doctor, “is about a minute and a half”.
“So this is not something that costs a lot of time. And it actually can save time, it can save money, it can save unnecessary investigations. And it can save a lot of stress and anxiety for patients and their families.”
Dr Reilly hopes narrative medicine, and a focus on skills like listening and empathy, extend further into medical training and into medical practice.
A good doctor needs “scientific knowledge and technical skill”, she says.
“But they also need insight and the ability to interpret a story. And they need an ethical framework in which to situate that so that they can make a deep and important and trusting connection with their patients.”
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