The business case for better listening

Despite the crunch on physicians' face time with patients, more astute listening may be key to better, more cost-efficient care. Examples of scenarios in which missing pieces of a patient's story has led to misdiagnosis (the leading cause of malpractice cases) and inappropriate treatment (a leading money waster) abound.

In a commentary for the New York Times, for instance, Nirmal Joshi, M.D., the chief medical officer for Pinnacle Health System, described a case in which a patient suffering from side effects of an over-the-counter weight-loss supplement containing ephedrine was wrongly determined to have an anxiety disorder causing heart symptoms.

Family physician and blogger Davis Liu, M.D., shared a story of a similar near-miss in a post for KevinMD. In that case, it was a simple conversation with the patient about the details of his pain and how he responded to treatment that made all the difference between providers continuing treatment for the wrong diagnosis--diverticulitis--and correctly identifying and treating his kidney stone.

"If we had simply concluded that since Mr. Smith was doing better, we should continue with treatment and finish his antibiotics we would have been making a mistake," Liu wrote. "If we had advised him that if his symptoms should come back, it would be due to his diverticulitis and that he would need antibiotics then we would have been an error. It would have been a misdiagnosis, a diagnostic error."

Although medical schools now add physician communication skills into their curriculum, Joshi noted, providers in school prior to 1999 have not had exposure to this training. Encouragingly, however, he reported that a program he and his colleagues began in an urban hospital system in Harrisburg, Pennsylvania, three years ago has demonstrated promising results.

"I realize that many colleagues may see methods like ours as too intrusive on their clinical practice and may say that they don't have the time," Joshi wrote. "But we need to move away from the perception that social skills and better communication are a kind of optional extra for doctors. A good bedside manner is simply good medicine."

To learn more:
- read the article
- see the post