A couple of weeks ago, as I was finishing up a weekend of surgical coverage, the hospital CEO quipped, “How come you weren’t in the OR where I can be making money off you?” I replied, “I did something far more important. I spent over one half hour each weekend day listening to Dr. X.”
Dr. X is a revered retired internist and past President of the Medical Staff who unfortunately developed an acute abdomen during chemotherapy and was suffering a prolonged postoperative recovery. He had experienced a number of frustrating setbacks, which he found difficult to express for fear of being labeled a complainer.
Fortunately, he and I had known each other for over 5 years and settled into a relaxed banter as I changed his dressing Saturday morning.
“You know what bugs me the most,” he asked.
“Tell me,” I replied.
“That after all this inpatient care is over, I still have metastatic cancer. You are the first physician I have said this to. I feel with everyone else that whenever they hear me complain about something that they cannot fix, they want to run and hide from me because it makes them feel incompetent.”

I sat next to him and nodded as he talked about feeling weaker and less mobile daily, wondering how it would play out. At the end, I asked him, “What would you like me to do for you?” He replied, “Just being there and letting me ramble makes me feel better already. I didn’t realize how much of this stuff I was keeping inside.” I told him that barring a surgical emergency, I would be back between 9 and 9:30 AM the next day to change his dressing and continue our conversation. Both he and his wife thanked me.

I had no idea why he felt that he could open up to me. What mattered most was that I listened actively to what he was saying and validated his concerns.
In “Caring for the Physician with Cancer,” (Cohn KH, and Holland J. Caring for the physician with cancer, in: Holland J., ed. Handbook of Psychooncology. N.Y. Oxford U. Press. 1989, 689-693), I wrote that the physician-patient faces four major issues:

1) Abrupt change of status, characterized by loss of independence and self-esteem
2) Inside knowledge of the limits of medical care and the complications of therapy
3) Helplessness due to dependence on others, loss of privacy, and the difficulty of making long-term plans
4) Fear of meeting the stereotype of the physician as a difficult patient, whom healthcare professionals shun; difficulty asking questions and venting anger

I wrote that anger can be a positive emotion when it is associated with spirit and determination rather than when it is directed at the healthcare team. All experiences associated with personal growth bring accompanying growth pains. Fortunately, most of us forget the pains more rapidly than the growth that they bring, which allows us to move out of our comfort zones and take on new challenges.

Dr. Michael Kahn proposed a six-step checklist in The Six Habits of Respectful Physicians:

• Ask permission to enter the room; wait for an answer.
•  Introduce yourself; show your ID badge
•  Shake hands
•  Sit down. Smile if appropriate
•  Explain your role on the health care team
•  Ask how the patient feels about being in the hospital

What Dr. Kahn proposes is a great start, since patients form first and often lasting impressions within the first minute of the doctor-patient encounter. What I remember from medical school training is a patient bragging about her physician, “He made me feel like I was the only person in the world!” Listening differs from hearing in that hearing is passive, while listening is active and requires energy.

Caro proposed a five-step active listening checklist, using the acronym CLOSE (Caro J. The Power of Effective Listening, Shawnee Mission: National Seminars Publications; 1989):

• Concentrate on the speaker, maintaining comfortable eye contact
• Listen with multiple senses
• Open one’s stance to convey receptivity
• Suspend judgment to maintain objectivity
• Empathize, trying to put oneself in the speaker’s frame of reference, using summary questions, such as, “Do I understand you to say….,”

What do you think?

• What challenging and rewarding experiences have you had treating physicians
• What strategies and tactics have you found helpful
• What have your experiences treating physicians taught you about the art of medicine

As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn
© 2009, all rights reserved