The best sort of people are those who create space for stories. They can sit with an uncomfortable story without minimizing it, interrupting, looking for the bright side, correcting the storyteller or running away. - Bird’s Eye View
Patients are often asked to tell stories of themselves, but the story has to fit exactly into health care’s narrow template of what a patient narrative should be.
In my experience having cancer, only a slice of my physical story was ever requested. When I was in treatment, I was just a flurry of diagnostic imaging and pathology results on a computer screen. Oddly, nobody even asked for my entire medical history. If I even introduced physical side-effects as part of my story during a clinic appointment, I was quickly shrugged off or dismissed.
There is no greater agony than bearing an untold story inside you. - Maya Angelou
The story of how I was emotionally, mentally or spiritually? Well fuggedaboutit. Nobody ever asked me about that. That part of my story was entirely untold. I ended up gathering up the non-medical bits about me having cancer and telling them myself in my own damn book.
My newest Lesson Plan is about the practice of listening. If I'm talking about storytelling, I have to talk about story listening too. In the Lesson Plan, I read a book chapter called The Patient Storyteller and then ask questions about my story so students can practice their listening skills.
Before you even get to listening, you have to create a safe space for people to tell their story. Safe spaces have to do with trust. Why should a patient you’ve just met trust you and feel comfortable telling you the truth? Just because you wear a white coat? I’m not going to lie – this is hard stuff – in some ways, harder than memorizing the Krebs Cycle. That’s why calling interpersonal skills ‘soft skills’ is so ridiculous. Working with people is much harder than knowing facts.
Once you’ve created that safe space, you need to ask the right questions to get the story rolling. Don’t ask the wrong questions. Be value-neutral and careful with your words. Be truly present in the moment. Don’t interrupt the telling of the story. Let the patient know you are listening by sitting at the level of the patient (don't having a big barrier like a desk or a computer between you), make eye contact, minimize distractions, ensure privacy -- and smile and nod. See? That's a lot.
But that's not all. Then there are the aspects of listening. Listen to understand. Don’t listen with the intention of only thinking about what your response will be. This is like reading comprehension – are you listening to hear what the speaker is really saying, or are you just listening to the words? This isn’t a boxing match. You don’t always have to respond with counterpunch, a fix or an answer. Often just being given the space to be heard is enough.
When we avoid an important topic, we miss an opportunity to strengthen that alliance. – Dr. Jon Hunter.
Watch this clever video from Dr. Jon Hunter and Dr. Bob Maunder about asking the right questions. The video is about asking about Adverse Childhood Experiences, but also speaks to the importance of asking the right questions, even if they are difficult.
I’ve been told that health professionals can be reluctant to ask anything about the patient beyond the check-box of the medical because of a worry about opening a Pandora’s box. Clinicians don’t necessarily fancy themselves as mental health professionals, so they are reluctant to hear anything except for facts about symptoms and lab results. They are concerned if that if the Pandora’s box’s lid gets cracked, even a little bit, that they will be sitting there for two hours in a makeshift therapy session. So let's look at the research from the book called Compassionomics.
In a busy outpatient clinic, researchers measured how long it takes for physicians to hear and respond to patients when an opportunity for compassion arises. On average: 31.5 seconds. - Stephen Trzeciak, MD, MPH
31.5 seconds. Listening, believing patients and acknowledging what they are saying can take very little time. Giving us the space to tell the story we need to tell and then listening closely may in fact save you time later on. Maybe if a patient does need two hours with a mental health professional, you could help them find the help they need? Could one of the colleagues from your team support you? Perhaps other parts of the patient story, beyond the medical, are important to their overall health - so mental health is actually in your lane too?
If nothing else, listening will start to build a connection based on trust. All good relationships in health care begin with a foundation of trust.
Listening to understand is the way to honour a patient and their story. Here’s the thing: for me as a patient, feeling seen, heard and validated, even for a few seconds, is simply priceless. That is why the story listening is just as important as the storytelling. Now please - go forth and listen.
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