Oliver Sacks’ memoir: That good doctoring requires

In reviewing Oliver Sacks’ memoir, On the Move:  A Life, book reviewer Andrew Solomon captured the spirit of narrative medicine.  I once saw a carpenter at work, tapping a nail once to set it, and then with a decisive second stroke, driving it all the way home.  Solomon hit the nail on the head just like that:

“The emergent field of narrative medicine, in which a patient’s life story is elicited in order that his immediate health crisis may be addressed, in many ways reflects Sacks’ belief that a patient may know more about his condition than those treating him do, and that doctors’ ability to listen can therefore outrank technical erudition.  Common standards of physician neutrality are in Sacks’ view cold and unforgiving – a trespass not merely against a patient’s wish for loving care, but also against efficacy.  Sacks has insisted for decades that symptoms are often not what they seem, and that while specialization allows the refinement of expertise, it should never replace the generalism that connects the dots, nor thwart the tenderness that good doctoring requires.” 

In Awakenings and The Man Who Mistook His Wife for a Hat, among other books, Sacks describes how he acts as an ally with patients.  He doesn’t cure them, but as a caring thought partner with them, he finds ways to free them from the most imprisoning limitations of their plights.

Advice:   Let’s read Oliver Sacks’ memoir.

Read an example of the use of narrative medicine.  Thanks to Andrew Solomon for his book review in The New York Times of May 17.

I can’t hear you while I’m listening: Communicating with your doctor

A stethoscope amplifies inaudible heart and lung sounds in a very satisfying way. If, however, the owner of the organs under evaluation decides to make a comment during the exam, what results is a painfully loud, unintelligible blast of noise directly into the doctor's head.

It was during such an interruption almost 30 years ago that Dr. Richard Baron, a Phiadelphia internist, grumbled at his patient: "Shhh. I can't hear you while I'm listening." The phrase has undoubtedly been said by many, but Dr. Baron was the one with the wit to stop and laugh (and reflect at length in a classic medical article), realizing that he had enunciated in pure koan form probably the single greatest tension in modern medical practice.

Against the siren song of all those beautiful instruments and machines, whatever the patient has to say is sometimes just an annoying interruption.

This is a caution about the use of technology. It's also a caution to patient advocates, to ensure we don't get in the way of the doctor's listening to the patient.

Advice: Find a doctor who listens to you – and do your part by enabling him or her to listen fully, in every sense of the word.

Read another physician listening story. Thanks to Dr. Abigail Zuger for the source story in the New York Times on Oct. 27.