Generally speaking, clinicians do not listen to exactly what a patient says. When a patient speaks she is speaking from herself as a whole. When we listen very carefully to exactly what she says we have, potentially, a doorway into the whole.
For instance, I asked a woman, a 43 year old office manager, ‘when did your (awful) cough start?’ She said ‘Soon after I arrived in New Zealand (...) years ago’. Why didn’t she just tell me ‘(...) years ago’? But she chose to also tell me that it was ‘soon after I arrived’. There is the doorway. I asked her why she had left America. She said her husband had been working 12 hours a day, and that she had felt like a solo mother. Together they decided on a new start, and emigrated. But soon after arriving in New Zealand they were back in the same old pattern. She developed a respiratory infection, and her cough began, and it never disappeared, despite expert medical intervention. It got much worse years later when her husband admitted to gambling away their financial resources, and the marriage ended. The cough represented her thwarted desires for a close relationship, her deep disappointments, and her frustrations that despite her best efforts as a wife and mother she could not achieve a close relationship.
Generally speaking, clinicians do not listen to exactly what a patient says. When patients speak they are speaking from themselves as a whole. When we listen very carefully to exactly what they say we have, potentially, a doorway into the whole.
That little phrase, ‘soon after I arrived’, floated onto the surface of her conversation with me. I was listening intently, and took the precise words very seriously. I started to wonder why ‘soon after I arrived’. This led us to aspects of her life and condition that had never been discussed medically, and to the source of the cough. In a sense, the cough represented all of who she was and has become.
I am reminded of the Holographic Principle, where the ‘thing’ or ‘piece’ presenting on the surface represents or holds the ‘whole’ that is beneath or behind the surface. Clinicians need to slow down, listen very carefully to exactly what a person says, take what is said seriously, not go hunting for more and more surface information, but gently dive in through the words already offered. When a person speaks to us they are, in some way or another, exposing a potential doorway into their whole. Most people fear that it will take lots of time. I think it takes careful listening to the little that is given.
In the Clinicians section of this website there is a 14 piece mini-series on the skills of listening.