My doctor isn’t listening to me! How you can help

The most common complaint about physicians on the Internet is, “They didn’t listen to me.”

You were sitting in the office and the doctor was physically present in the room, but they weren’t all there. Even worse is when the doctor doesn’t try to understand what you are going through. Sometimes it can seem like they didn’t even care.

Most of us take for granted that we are the center of the doctors attention when we are face to face in the office. They are supposed to listen, care and empathize with our situation. That’s what we pay them for. They are our medical expert and a powerful shoulder to lean on when we are in need.

There are invisible forces present on most office days that can block your doctor’s ability to be a caring presence, turning you into the “runny nose in room three” from their perspective. It isn’t fair and most of us would say it’s not right, and these forces can explain why your doctor may not have been a very good listener today.

Distractions, work overload and stress

You are one of dozens of patients this doctor is seeing today. They have dealt with a number of problems before they walked into your room and they know there are many more patients to see before they can head home to their family. They have dozens of loose ends in the form of test results that aren’t back yet, patients not responding to treatment who are coming in for an urgent visit and much more.

Being a doctor is stressful. Continuously caring and being empathetic is an impossible expectation. When doctors are under stress the first thing that goes is the ability to listen and care. Unfortunately, these are also the two most important things to you as the patient. There is even a name for this symptom of stress in healthcare: compassion fatigue. No one has an endless supply of compassion. When it is gone, the ability to listen often goes along with it.

Burnout

Burnout is a direct result of the chronic stress of being a physician and it is much more common than you might realize. Studies have consistently shown symptomatic burnout in an average of one third of physicians on any given office day, worldwide, regardless of specialty. In some studies the burnout rate is over 70%. It is an epidemic in medicine that is not widely acknowledged outside of the research studies. Your doctor may be suffering from burnout on this particular office day.

Burnout renders your doctor one of the walking wounded in our healthcare system. They are exhausted, cynical and their listening and compassion skills are offline. The same studies show burned out doctors make more errors, provide lower quality care and their patients are less satisfied.

The superhero syndrome

In our training we learn to be superhuman. We work 120 hour weeks dealing with critically ill people always putting our own needs last. Doctors often feel guilty when we take time for ourselves and our lives often become very unbalanced. Recharging our batteries is not something we are taught – in fact it is frowned upon. So instead of noticing stress and burnout and taking a break, we do what we have always done – work even harder. We have never been taught how to get our needs met which leads to the high burnout rates above.

What you can do on your next office visit

The next time you are in the office and your doctor hurries into the room 30 minutes late – realize that it wouldn’t be unusual for them to be stressed, too busy, verging on burnout, distracted and very challenged to listen and empathize with your concerns. I consider it a miracle that doctors manage to be as compassionate as they often are. No matter how your doctor seems on this day, here is something you can do to help them re-center. Sometimes even a superhero needs a little support.

Help them take a big breath

Say hello. Ask them to take a big breath with you and let go of everything else that might be going on in their day – you do the same – so that both of you can be fully present together right now. This little cue lets the doctor know you have some understanding of the pressure they are under and reactivates their compassion and ability to listen.

You might feel this is an outrage — that it is the doctor’s job to be a compassionate listener no matter what. I also know what it is like to be on the other side of your office visit. I assure you this will make a huge difference to your doctor. It would not surprise me if they thank you and remember your act of kindness for the rest of the day. They will love the fact that you noticed and cared – the very same way you appreciate their caring and concern. And you will have a much better office visit.

That breath will clear the air and allow them to focus all of their attention on you. You will be able to connect in a way that would have been impossible without it. They will listen. Try it next time and see.

Dike Drummond is a family physician and provides burnout prevention and treatment services for healthcare professionals at his site, The Happy MD.

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  • http://ClinicalPosters.com ClinicalPosters

    Excellent article. As patients, we can approach office visits with our own compassion fatigue. What a mix when both parties in one room have it. Hopefully, everyone will read this and begin building the bridge of empathy. Would love to repost on my blog.

    • http://www.thehappymd.com/ Dike Drummond MD

      Thanks for your comment ClinicalPosters. Yes indeed … the worst is when a patient with a chip on their shoulder meets a burned out doctor on a bad day.

      Please contact me through the website for reprint rights

      Dike

      Dike Drummond MD

      http://www.thehappymd.com

  • Jonathan

    I think that “my doctor didn’t listen to me” is such a common complaint because people mean so many different things by it. Sometimes it really is “he didn’t correctly hear and mentally process what I said”. Other times it’s “he disagreed with me about the cause of my symptoms”, “he didn’t consider my symptoms to be as serious or urgent as I thought he should have”, or “he didn’t give me the treatment I wanted”, among other things.

    I’ve also worked with a lot of docs (I teach residents) who clearly were listening whose patients still didn’t feel “listened to”. And vice versa.

    This is a hard complaint to pin down and a harder one to fix. Your advice for the patient side is good–some docs may resent it, others may humor the patient, but if nothing else it reminds the doc to be “on” and to not disappear into his head.

    • http://www.thehappymd.com/ Dike Drummond MD

      Thanks for your comment Jonathan. It is actually quite easy to “Hear” a patient in a way that they won’t say “He didn’t listen to me” and it absolutely involves a different level of communication than what occurs in the typical doctor patient visit.

      You listen and then tell them, “This is what I heard you say ….” and tell them what you heard.
      If you didn’t hear them correctly … they will tell you so in exquisite detail.

      This is a communication technique used widely in Mediation to make sure both parties have a clear understanding of the other side’s position.

      If you want to know how serious they think their concern is … ask them to rate it on a one to ten scale. You will instantly know where their “concern meter” is set.

      ALL communication blocks can be addressed … you can’t just stand there and blame it on the patient or medicine or allude that it can’t be done … because that is simply not true.

      Dike

      Dike Drummond MD

      http://www.thehappymd.com

  • http://twitter.com/DrLeanaWen Leana S. Wen MD

    Great article! At the risk of shameless self-promotion, I want to put a plug for my new book, When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests. http://www.whendoctorsdontlisten.com/. It precisely addresses the issues that Dr. Drummond writes about, and provides a practical guide for patients to make sure your doctors listen.

    • http://www.thehappymd.com/ Dike Drummond MD

      Plug away Dr. Wen. Happy to give you the opportunity on this incredibly important topic.

      Dike

      Dike Drummond MD

      http://www.thehappymd.com

  • Steve Wilkins

    I recently accompanied my wife on her visit with her Oncologist. Were were talking about how insurance companies are trying to reduce the number of unnecessary imaging procedures like PT/CTs. He told us that 2-3 times each week he has to get on the phone with insurers on behalf of patients to justify the need for an imaging procedure.

    He told how the previous Oncologists, from whom he recently bought his practice, stopped advocating with insurance companies on behalf of patients because they were so burned out. Chances are had they called on behalf of their patients the needed procedures would have been approved as they are for my wife.

    Physician burn out is a problem that not only affects how doctors talk with patients…it also directly affects the quality of patient care.

    Thanks for bringing this issue to everyone’s attention Dr. Drummond!

    Steve Wilkins
    http://www.healthecommunications.wordpress.com

    • http://www.thehappymd.com/ Dike Drummond MD

      Hey Steve, I completely agree. The negative effects of burnout are pervasive. Here are just a few.

      Higher levels of burnout are directly linked to
      Lower quality of care and lower patient satisfaction
      More medical errors, poorer clinical decision making, higher malpractice risk
      Higher physician and staff turnover
      Higher rates of depression, divorce, drug an alcohol use and suicide for the doctor

      IMHO it is a moral/ethical imperative for doctors and their organizations to monitor and actively prevent burnout in the docs. Unfortunately a meaningful physician wellness program is VERY rare.

      Dike
      Dike Drummond MD
      http://www.thehappymd.com

  • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

    What an excellent article. When I have to see my doctors, I will at times ask them if they are feeling ok before we get on to talking about why I am there, and sometimes I will ask them how their family is. We all need this reminder from time to time. Thanks for sharing it.

    • http://www.thehappymd.com/ Dike Drummond MD

      Thank YOU for being so compassionate and caring with your doctors. I sincerely hope they are returning the favor.

      Dike
      Dike Drummond MD
      http://www.thehappymd.com

      • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

        Thank you in return for your response. Yes, they do return the favor. I became an even stronger advocate of doing this because of the time that I spent on my externship when I went to school to become a Medical Assistant. I learned some valuable lessons while I was there, and also got to see just how hard all of you work. This is especially the case for Primary Care (which is where I did my externship, in a Family Medicine office).

  • rswmd

    Patients need to realize that at least one-third of the office visit that they are paying for is now dedicated to data entry and MU chores (and how long is that visit to begin with? Some of the hospital-owned practices in my area are now being told to schedule every 10 minutes, in order to offset the enormous administrative overhead they have assumed.)

    Patients hate it, doctors hate it: Big Data rules.

    • http://www.thehappymd.com/ Dike Drummond MD

      Thanks for your comment rswmd … what you are saying is true and no different than it has been for the last 30 years. The administrative aspects of your patient visit can be handled in a way that they do not come between the patient and the doctor. You can communicate well and build your relationship as you tell your patient how to “work your system” as well.

      We have MUCH to learn from the hotel and other service industries.

      Dike

      Dike Drummond MD

      http://www.thehappymd.com

      • southerndoc1

        “no different than it has been for the last 30 years”

        Disagree. The expectation/requirement that the progress note be completed and signed, a visit summary be generated, and MU chores finished all by the time the patient leaves the exam room is something new.

        If we give the doc permission to do computer tasks during the visit, don’t we have to allow the patient to text, game, etc.?

        A doctor who thinks she can compose, organize, and type a worthwhile progress note while having a meaningful conversation with a patient, is a doc who thinks she can text while driving.

        • http://www.thehappymd.com/ Dike Drummond MD

          OK now I see exactly what you are saying. And … just to be clear… you are voting with your feet to be a cog in that kind of machine every day you walk into work. You don’t have to work in a system like that if you don’t want to – there are options that sound like they would be more healthy for you and your patients.

          You also point out the “deal with the devil” that a lot of docs in private practice have made recently by selling their practice to the local hospital system. I wrote about it here.
          http://www.thehappymd.com/employed-physician-is-respect-a-number/

          Dike
          Dike Drummond MD
          http://www.thehappymd.com

          • southerndoc1

            Agree completely. “Deal with the devil” is right!
            Actually, I have voted (with my tush) not to work in that sort of environment, but most of my peers have given up and gone over to the dark side. I would love to see more docs resist the lure of MU pennies, but that seems unlikely.
            My original point was that patients need to realize that, in offices that have gone that route, a significant chunk of their office visit is now dedicated to data entry. If they are tired of looking at the top of their doc’s head bent over a lap top, they should protest loudly and vigorously.

          • http://www.thehappymd.com/ Dike Drummond MD

            Congratulations on your successful “escape” ;-)

  • http://twitter.com/Coachpatrickv Patrick C. Veroneau

    I would agree that empathy needs to work in both directions for genuine connection. When we feel as though someone is making a genuine attempt to put themselves in “our shoes,” it is always easier to deal with an unpleasant experience. Training in the area of emotional intelligence can provide great value.

    • http://www.thehappymd.com/ Dike Drummond MD

      Thank you for your comment Patrick. EI and compassion and communication training are essential to developing this skill if the individual med student is not hard wired and raised to have them in the first place. Because med school admission is usually based on skills in the sciences … this skill set is rare and medical education is so “full” already, these “soft skills” are rarely addressed with any effectiveness. It does not have to be that way. A skilled clinician and an empathetic doctor are not mutually incompatible.

      Dike

      Dike Drummond MD

      http://www.thehappymd.com