Time to Listen (commentary), A

When teaching my students about what goes into a good doctor-patient interaction, I tell them about the studies that show how quickly doctors interrupt their patients. Male physicians especially, I tell them, are notorious for stopping the patient mid-sentence to redirect the discussion. In one study that I came across, female primary care physicians waited an average of 3 minutes before interrupting the patient to redirect the discussion toward issues more relevant to diagnosis. Male physicians waited an average of 47 seconds.

How long do I wait, I wondered? I decided to try an experiment. I would let my next patient talk as long as he or she needed to explain his or her reason for seeing me. I would watch the clock and see how long a patient might naturally take to explain the presenting complaint. I would hold my tongue.

The patient was in her 70s and greeted me with a smile when I stepped behind the curtain to be with her. "Hello, I'm Dr. Barr. What's the problem that brings you in today?"

She began to describe the past several weeks of her life. As I recall, it had to do with a coworker noticing something, talking with her sister on the phone, and her reluctance to see doctors. The word "cough" surfaced for a second, then quickly became submerged again. Looking at the medicines on the shelf at the drug store and not knowing which to choose. ... Needing to dress warmly ... (Wasn't this weather we'd been having nasty?) ... Sometimes she had trouble sleeping ...

The nurse poked her head through the curtain and silently tapped her watch. The waiting room of our urgent care center was full, and things were starting to back up. I wouldn't budge, though - I turned back to the patient and nodded. However long it took, I would wait for the patient to stop of her own accord. I wouldn't butt in.

It was the cough that was keeping her awake. ... She always got colds more easily than other people. ... Her sister was just a worrier. ... She finally had agreed to come in to see a doctor, just to reassure her friends and family.

Twenty-two minutes, from start to finish. The nurses were never going to forgive me.

The lungs had left-sided rales. The fever was mild, but the white count suggested infection. The chest radiograph showed a large infiltrate on the left and what I feared was a mass. I called the pulmonary specialist across the street and asked if he could squeeze the patient in this afternoon. He did, only to confirm the worst. It appeared the patient had a tumor causing the infiltrate, and there probably were enlarged hilar nodes as well. She probably had lung cancer, and it was probably in an advanced stage. She needed antibiotics right away to get the infection under control, after which further testing would be arranged.

The patient came back to our center for the antibiotics. The specialist had told her what he had found and had given her an indication of the grave prognosis she faced. I stepped back into the patient's space and said with sadness, "This hasn't been a very good day for you, has it?"

She looked at me for a moment with an unmistakable smile on her face. She reached out her hand and patted me on the wrist.

"Oh, don't worry about all that. I've had a good life. But I just wanted you to know - this is the best doctor visit I've ever had. You're the only one who ever listened."