The power of summary

Wooden Blocks with the text: SummaryPREVIOUS: Co-constructing the story

Accurate summarising is a mature skill that can make a big difference. Let’s assume you have learned to listen very carefully, and you have developed the capacity to respond accurately and with genuineness and delicacy. You have heard multiple elements of the story and you have been empathic. And a pattern is emerging. You have conversed enough with each other, and you have some confidence that the patient’s symptoms are appearing or worsening in relation to important things happening in her life. At this point it can be very helpful to summarise what you are hearing and perceiving.

A summary may be a mixture of things like: ‘As I’ve been listening I have noticed that your symptoms began 12 years ago when you came from America. It sounds like you partly came because you wanted a new start, because you were feeling that your relationship with your husband was not what you had hoped. But when you got here the same pattern developed. It seems that you started to feel that, despite the big changes, things were really no different. And your cough began around that time. And it got worse when you found he was having an affair. I wonder whether your cough maybe partly related to your feelings about all this. I may not have got all of that exactly right, but perhaps there is something in there for us to think about.

It is important to be tentative.

There is no need to press the point or to be emphatic or certain. The patient should be given the room to modify, refine, and of course correct what you have said. After all, this story-gathering is a collaborative process rather than a diagnosis by an expert. Summarising requires quite a bit of skill and needs considerable practice. Patients feel even better heard and understood if the clinician has a coherent and accurate grasp of what they have been saying, and can reflect this back in a simple and accurate way. It is important to be tentative. The chances of you being EXACTLY right are low. Being reasonably accurate is good enough—it gives plenty of room for the patient to provide the more accurate version, and thus feel in charge of their own story.

Brian Broom

NEXT: Educating about illness and story connections