“Doctor I’m bleeding, are you listening?”

We must train doctors of the future to really listen to patients in order to get the best information so that they can deliver better, safer care. Professor Michael Buist, Chief Medical Adviser at Patientrack, internationally respected practitioner and patient safety pioneer; provides a very real and personal account of what the patient safety agenda is lacking.

 

There are many fantastic people that make our health systems tick. But often our doctors and our managers don’t listen. This is one of the causes of adverse events in our healthcare system.

My daughter Hannah Grace was stillborn on my own birthday in August 2008. My wife Sarah had noticed a reduction in Hannah’s movements when she was 26 weeks pregnant. The next morning Sarah went to see the obstetrician again, feeling very concerned that something was wrong. The obstetrician reassured Sarah and on finding the baby’s heartbeat said in jest, “See, you are making it all up, aren’t you”. The obstetrician then organised a scan, for extra reassurance. Hannah didn’t move for whole scan and wasn’t seen breathing. The person who did the scan concluded she was a lazy baby. The following morning, there was still no movement. We went to the maternal-foetal unit, for another scan. This time there was no heartbeat.  

My wife Sarah is a lawyer with a PhD. She is no fool. She knew the baby wasn’t moving. What made her really angry was that the obstetrician was just talking to his medical students about her “interesting obstetric history”, and made light of her concerns. She felt totally as though no one was listening to her.

Two months later I had appendicitis. I was extremely unwell after the operation. After carrying out an ECG medical staff assumed I was having a heart attack. I knew my medical history and my normal readings and knew this was not the case. But, in my own hospital, the attending doctor told me to “be a good patient”. It was after only a phone call from my brother, who is a doctor, and my repeated insistence to medical staff to “get the surgeon, I am bleeding” that saved my life. After being told “there, there”, I was eventually returned to the operating room where I had a blood transfusion and ended up in intensive care.

My experience with the obstetrician and my own colleagues got me thinking. We don’t listen, or we listen to what we want to hear. We need to be taught to listen. This is what the patient safety agenda has been lacking.

We must train tomorrow’s doctors to listen

The reality is that excellent standards of care are delivered by many wonderful people in our hospitals today. But people receiving care should not be told to be the good patient, a term that implies to be quiet and do what the clinician tells you. We actually need patients to be BAD - Better informed, Ask questions and Discerning.

We must focus our services around the patient and that means listening. The future of the health and quality agenda rests with our students. We need to teach them to listen and to think.

The traditional way we teach our medical students beats the intuition out of them. They have to learn that subsequently in the rough and tough on the wards, in the clinical departments and in theatre. Many of today’s junior doctors know their discipline extremely well but few have been taught how to listen to the 80 year old woman in the hospital bed.

Students need to be taught much more than a checklist approach to finding out about their patient. Being task orientated is simply not enough. They need to learn how to listen to the patient. They need to be able to hear the clues the patient gives, the half gaps. I am taking this approach with my students today.

I also get my students to go to the bedside and just look at the person for 60 seconds and see if they can make a diagnosis based on intuition. This is about training students to think about the person. The check list may have been filled out – but have they thought about the obvious?

Feedback from my students indicates that they now understand the need to make care truly patient focussed and that to do this they need to interact with patients in a normal way. They need to ask about the patient’s life to find out valuable and meaningful information that could really make the difference in a diagnosis.

Interacting with the patient is in many ways like dating, the best of which are those with two way interaction. Healthcare professionals need to strike this balance. They shouldn’t talk over patients and equally they need to provide enough information.

A cultural model of adverse events

Listening to our staff is just as important. There is still a pressing need to improve the way we communicate, a cultural challenge that has been highlighted in cases like Mid Staffordshire.

At present in many hospitals it is the junior nurse at the bedside who must go around and around to decide whether to communicate information to a senior nurse. The senior nurse then makes decisions who he or she will talk to and what to say about the patient. The decision to call the junior doctor often depends on who that doctor is. There are some people who just do not want to be communicated to. And a generational divide means that junior doctors do not like to call senior doctors – the grey haired people like me.

People do not always comply with policy or procedure. We need to really listen to change this.

Managers need to think much more about what is happening on their shop floor. To do this, they need to talk to the people on the frontline.

I would love to see a time when for 12 months no hospital policies or procedures were written. If that time was instead spend talking to junior doctors, to junior nurses and other people on the frontline then we could really understand their experiences and how they see the universe. We are now at the beginning of this exciting journey.

Author Michael Buist:

Professor Michael Buist is an internationally respected commentator and pioneer in patient safety. A senior critical care and general medicine practitioner, Professor Buist is chief medical adviser at Patientrack. Also an academic, he regularly speaks at international forums and conferences and is widely published on the subject.

 

Michael's story can also be viewed on ABC's Australian Story.

 

As originally appeared in The Guardian.

 

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