医生如何成为更好的倾听者

根据在美国医学协会期刊研究，在治疗过程中，如果一名医生能够仔细聆听病人关于工作与生活的聊天，将有助于他们找到更好的治疗方案。本期节目中我们邀请了芝加哥伊利诺伊大学施瓦茨教授一起来谈谈作为医生怎样能成为更好的倾听者。

IRA FLATOW, host:

This is SCIENCE FRIDAY, from NPR. I'm Ira Flatow.

Last time you went to the doctor's office, how interested was your physician in your lifestyle? Did your doc chat with you about topics not directly linked to your health, like maybe how you lost your job recently, or you've been stressed out taking care of your sick daughter, or you've been skipping breakfast lately?

That is not just small talk. Your doctor, according to my next guest, should be listening carefully to what's going on your life, to pick up on the little clues that might help give her the best treatment that she can.

How many doctors are actually listening to the details, and can they get better at it? A new study out this week in the Journal of the American Medical Association suggests that they can. So do we have to retrain all the doctors, or maybe just start with the med students?

That's what we'll be talking about. Our number: 800-989-8255. If you're on Twitter, you can tweet us. Write the @ sign followed by scifri, S-C-I-F-R-I.

Alan Schwartz is an associate professor and director of research in the Department of Medical Education. That's at the University of Illinois in Chicago. He joins us today. Welcome to SCIENCE FRIDAY, Dr. Schwartz.

Dr. ALAN SCHWARTZ (Associate Professor, Director of Research, Department of Medical Education, University of Illinois at Chicago): Thank you very much, Ira.

FLATOW: What was the problem that you were looking at in your study?

Dr. SCHWARTZ: So, my colleagues and I, in an earlier study that came out this year, had found that physicians, attending physicians, weren't always good at picking up on cues that patients were giving about important things in their life that really needed to be attended to in order to plan the right kind of care for these patients.

So we set out to find out if we could improve physicians' abilities to do that.

FLATOW: And could you do that?

Dr. SCHWARTZ: We could. So in the study that just came out, we took the medical students at the University of Illinois at Chicago and divided them into two groups and trained half of the medical students with a workshop designed to sensitize them to the importance of patient context and give them some skills at listening for it and incorporating it into planning treatment. And that group did much better than the usual performance of our medical students.

FLATOW: Can you translate to doctors, or do you have to just retrain medical students now? What about the old pros who are entrenched?

Dr. SCHWARTZ: Well, this is a great question, and our study focused on medical students, because we think that this problem is, in large part, a problem of training, and that it's an important thing to deal with early on in medical training.

But we have another study going on now that's working with residents, and I expect at some point, we'll have a study that's looking at practicing docs, as well, and improving their skills.

FLATOW: Dr. Schwartz, can you give us an example of the kinds of things that doctors should be listening for and don't?

Dr. SCHWARTZ: Sure. I think you gave a great one at the top of the show. In one of our cases, we use actors playing patients. So they play the same role all the time, consistently. And in one of our cases, the actor mentions that he's come in because his asthma is getting worse. And at some point in the visit, he says: And things have been tough since I lost my job.

And what we'd like to see is that the physician doesn't just say, oh, I'm sorry to hear that and go on, but asks some questions about that. Because if the patient has lost their job, and this means they can't afford their medication, they may not be using it properly, and simply prescribing a higher dosage is not going to help this patient.

FLATOW: Mm-hmm. So you would try to find a solution if they've lost their medication, and they're not taking their medication.

Dr. SCHWARTZ: That's right. So if the patient was supposed to be taking it daily, and because they can no longer afford it, they're taking it, you know, every other day or every third day, then the doctor would try to find a cheaper medicine or some kind of a referral to a program that could provide that medicine.

FLATOW: Is it a problem of lack of time with the patient? We hear that doctors, because they have to bring so many patients through their offices these days to make the kind of money they'd like to make, that they spend just a few minutes with their patients.

Dr. SCHWARTZ: So this is a really great question, and the answer is somewhat, but not entirely. So we know that for two reasons. First, in our earlier study of practicing physicians, we sent actors to visit these physicians in their offices. So they didn't know they were seeing actors. They thought they were seeing patients.

And in that study, we found that the amount of time they spent with patients affected whether they asked about these kinds of things but didn't affect whether they incorporated what they learned into the final treatment plan.

In this study with the medical students, because we were using standardized patients at our clinical performance center, the time for each encounter was controlled. So we know that whatever difference we see here between our usual students and our trained students, it's not due to giving them more time to explore this with the patient.

FLATOW: Now, it seems to me that it's one thing to pick up on these cues about the patient's life, but is the resulting care that much better when they do that?

Dr. SCHWARTZ: So that's an excellent point. If the physician doesn't get these cues, then they almost certainly won't be able to plan appropriate treatment for the patient. But even if they ask about these cues, even if the physician probes them and finds out the key information, they still may not incorporate that into their treatment plan.

And our studies suggest that that's a harder thing for physicians to do when the information is information that's unique to the patient about their context than when it's information that's really about the medical situation of their disease.

FLATOW: I have a question here from someone here who tweets, says: The longer the doctor listens to you, the more likely they will diagnose the illness correctly. They should listen for two minutes before talking.

Is there is that true? Should the doctor just sit there and listen without interrupting? Or what technique is involved that you suggest?

Dr. SCHWARTZ: Well, we train our doctors to listen for these cues and then to explore them with the patient. So I think that the point is very well made, that physicians do need to do a lot of listening. And they're trained, I think, quite well in general to do that kind of listening.

But they also then need to check back with the patient. The real skill here is really not hearing everything the patient says. It's hearing everything the patient says, determining what might be relevant for their care and checking back on that.

FLATOW: Mm-hmm. And doctors are I know of at least one case where doctors are now listening to patients while they're they're taking instant messages on their Blackberrys. At the same time their patients are in their office, they're answering other questions on their instant messaging. That doesn't sound like a good recipe to me.

Dr. SCHWARTZ: No, I would fire my doctor if he were doing that.

(Soundbite of laughter)

FLATOW: Unless it's the head of the practice. Okay, well, this is interesting. So you say you're following up with another study of physician training?

Dr. SCHWARTZ: Yes, my colleague, Saul Weiner, and myself and my other colleague, Ilene Harris, who are involved in the study that just came out, have a study ongoing where we're looking at resident physicians - so they've left medical school, but they're still supervised in their practice and applying our training to them and seeing if we can improve their ability to do this, not only with these actors, but also with their actual patients.

FLATOW: Interesting. And as far as that point you made about firing your doctor, is that something you, as a patient, should be watching for when you talk to your doctor, that he or she is following up and listening to you?

Dr. SCHWARTZ: I think that's an important skill, and one that we should expect from physicians. Now, I'm not saying that on any one visit, you know, if your physician is distracted, you ought to go and look for another doctor. But I think that a pattern of disregard for things that the patient feels are important in their life is certainly a red flag.

FLATOW: All right, Dr. Schwartz, thank you for taking time to be with us.

Dr. SCHWARTZ: Absolutely.

FLATOW: Alan Schwartz is associate professor and director of research in the Department of Medical Education at the University of Illinois at Chicago.