Listen to your patient, he is telling you the diagnosis – William Osler
I was talking about the state of medicine today with someone who should know – and learned that there is a serious problem with training new doctors in the developing world.
Privatisation of teaching inevitably results in the standard of teaching going down – as the superstars migrate to the highest paid and most prestigious roles and the rest staff the other places.
Doctors don’t know the basics – how to take a patient history, how to present their findings and how to do the things that doctors should learn to do.
The fact is that there are things that can be trained easily and there are things that can’t – like a good bedside manner.
And all this has been known for a long time.
William Osler came up with the idea of a medical residency – and the idea that students should see and talk to patients.
An essay of his titled Books and Men has this line:
“To study the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all.”
The first point we should take from this is that it’s not enough to read about things – we must practice as well in real life situations.
If you’re a writer, an artist, a salesperson, a consultant, a photographer – you will learn much by reading about it and you will learn much by doing it.
Doing both will make you brilliant at what you do.
Doing either one on its own will not.
Good, perhaps, but not exceptional.
Of course, you have to learn how to learn – and Osler has something to say on that, quoting an old writer who says there are four sorts of readers.
Sponges who soak up everything without asking or checking; Hour glasses that get knowledge and pour it out just as quickly; bags, that retain the dregs and let the wine escape and sieves that keep only the best.
Strive to be a sieve – it takes longer than you think.
And then there is the quote that starts this blog – which tells you all you need to know about the skill you need to have.
Too many people, many doctors don’t listen.
They look at the symptoms and make a diagnosis.
They sweep in, look at the person, the situation – and say what they think.
It’s something you see all the time – with managers, executives, partners – anyone in a position of authority.
What they want to do is get to the solution – and of course it’s the solution they have in mind.
People like that are very confident – they’ve been successful – that’s why they’re in charge.
Successful anyway in the sense that what they did or didn’t do can’t be measured and the people judging them had no idea what was really going on.
And the thing about people like that is they don’t want to listen – they might politely give you the impression they are but really they’re thinking about something else and will, as soon as they can, squish you and anyone else that’s in their way.
What such people don’t do is listen.
They don’t take a patient history – a situation history.
They don’t ask what has been going on, what’s the background, what’s the context – what led up to the events that are being considered.
And this is what you find when you listen.
The answer is in front of you every time – one answer anyway that fits the facts that you’ve now taken the time to gather.
It’s just sitting there hidden in plain view – and what you needed to make it visible is get people talking – and just listen.
And then, when you’ve listened, you can add your professional opinion.
You will now know what to name the problem, the disease, the condition.
You will know how to test for it, how to measure it, how to detect it.
And you will know what to prescribe, how to fix it, how to solve it.
It doesn’t matter what you do or how you help other people.
But you will do it better if you first learn to listen.
p.s. If you want to learn more about how I do this professionally, here is a paper I wrote today that sets it out in more detail.