To make a difference, we must first identify what matters most to patients, health care providers, and communities. To do this, we must all learn to ask open-minded questions and listen carefully.
To fix health care, we need a genuine democratic dialog.
To start that, our society needs a massive dose of listening to understand what really matters to patients and communities.
Because clinicians have been put on a treadmill driven by the pitiless demands of a false concept of efficiency.
Money has replaced quality care as the measure of health care. The idolatry of the market is driving a race among hospitals, insurers, and manufacturers to get bigger and bigger.
Pioneering cardiologist and Nobel Peace Prize winner Dr. Bernard Lown has said that the usual rules of efficiency are inverted in medicine.
The more time a physician spends with patients, the more efficient he or she becomes.
Listening costs next to nothing, and so is infinitely more cost-effective than drugs and devices. Listeningpromotes healing and causes no harm. In fact, it’s the bedrock of a genuine trusting relationship— something everyone wants from their doctors and nurses.
In the tone of voice, in the subtlety of the pattern of pain, in getting the sequence of events right — that’s how a correct diagnosis is made and the person emerges from the patient.
If all health care providers listened better, we would save billions of dollars and transform the system.
So why don’t we have the time we need to listen?
We’ve been told that a big problem with health care is inefficiency and waste. (It is.)
We’ve been told that old fashioned doctoring results in huge variations of care. (It does.)
We’ve been told that constant electronic nudging will make doctors better. (Maybe.)
Doctors are being told they must make their productivity numbers to keep their jobs and prove they are efficient. (Sad but true.)
The idea that more is better has many Americans going from doctor to doctor to doctor, getting test after test, and becoming increasingly anxious about our health while increasing the cost of health care.
The doctor-patient visit is becoming a commodified transaction rather than a collaboration.
Clinical life feels more and more like sprinting on a hamster wheel, chasing unproven metrics to get graded on “quality.” It’s no wonder that burnout is exploding among physicians across the country.
So I ignored the ultrasound results and listened to what my patient and her body were telling me.
When I said it would be perfectly reasonable for her to wait on surgery and check in with me every six months, she overwhelmed me with her gratitude and relief, like I had commuted a death sentence. This year, 10 years later, she finally had her valve replaced.