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AUTHOR:
Neil Baum, MD
Clinical Associate Professor of Urology, Tulane Medical School, New Orleans, LA
Author, Marketing Your Clinical Practice-Ethically, Effectively, and Economically, Jones Bartlett Publishers
It was January 12, 2007, during rush hour traffic in the metro station in Washington, DC. A nondescript man wearing a baseball cap and khakis began to play the violin. He played six Bach pieces for about 45 minutes. During that time, it was calculated that at least a thousand people went through the station, most of them on their way to work. Nearly everyone walked past the violinist; some leaving a tip, ranging from pennies to $5. The one who paid the most attention was a 3-year-old boy. His mother tagged him along, but the kid stopped to look at the violinist.
In the 45 minutes the musician played, only six people stopped and stayed for a while. About 20 gave him money but continued to walk their normal pace. He collected $32. When he finished playing and silence took over, no one noticed it. No one applauded, nor was there any recognition.
No one knew that the violinist was Joshua Bell, one of the top musicians in the world. He played one of the most intricate pieces ever written on a genuine Stradivarius violin worth $3.5 million. Two days before his playing in the subway, Joshua Bell sold out at a theater in Boston, with the seats priced at an average of $100.
This is a real story organized by the Washington Post as part of a social experiment about perception, taste and priorities of people. The question to be answered was if a virtuoso was in a commonplace environment at an inappropriate hour, are we still able to perceive beauty? Do we stop to appreciate it? Do we recognize talent in an unexpected context?
One of the possible conclusions from this experience could be: If we do not have a moment to stop and listen to one of the best musicians in the world playing the best music ever written, how many other things are we missing?
Perhaps the same thing is happening to American doctors. We are in a hurry to see large numbers of patients. We sometimes don’t listen to our patients; often interrupting them within 15 seconds after we start a patient interview. First, when we are so busy, we may miss clinical cues that will help us with the diagnosis and provide suggestions for treatment options.
I am reminded of a story by Sir Arthur Conan Doyle, the author of Sherlock Holmes, who was a medical student in Edinburgh, Scotland, and watched Professor Joseph Bell conduct teaching rounds. Dr. Bell was introduced to a lady with a daughter sitting beside her. Dr. Bell said to the lady, “How was your trip from Burnt Island?” The lady was taken aback and said, “fine.” Dr. Bell then asked about her ferry ride from Fife to Edinburgh. Again the lady responded with surprise. Dr. Bell asked about her other, older daughter that she left behind. The lady gave her answer in the affirmative. Finally, Dr. Bell asked about her work in the linoleum factory. Needless to say, the students were astounded and they felt for sure that Dr. Bell knew the lady.
Dr. Bell told the students that he had never met the lady before and that he recognized the dry red clay on her shoes, which only came from the area around Fife, and that the only way to reach Edinburgh from Fife was by ferry. He noted that the little girl had a coat that was too big and he correctly assumed that she probably had an older sister left behind. Finally, when he shook the lady’s hand, he noticed a dermatitis that is unique to linoleum workers. Certainly this made a huge impression on the medical students and reading it made a significant impression on me.
In this age of sophisticated technology ranging from computed tomography scans, magnetic resonance imaging, DNA testing, and stem cell treatment for diabetes, we have stopped observing our patients. We are missing out on an opportunity to learn about our patients when we first focus on what tests we are going to order.
Second, we place ourselves at risk for litigation when there is a breakdown in communication. Doctors, hospitals, insurance companies, and malpractice carriers have known for years that there is a direct correlation between patient satisfaction/patient complaints and lawsuits (American Journal of Medicine. 2005;118:1126.) Physicians have always prided themselves as being good communicators, but surveys show that we often overestimate our ability to communicate effectively with our patients. Improving communication with your patients means making the patient feel that he or she is the most important thing for that physician that day. Doing this will not only make you feel good and be a source of gratification, but will also reduce your liability and risk of lawsuits.
Third, we may be missing one of the greatest joys of a medical practice—to share a bit of ourselves with our patients and receive some insight about them in return. I had a patient with a bladder tumor who was seen in follow-up. I saw that he was reading the Saints media guide book, so I asked about the book. He told me he worked for the Saints taking care of the equipment before and after a game. I asked him to tell me just one Drew Brees story that wasn’t in the media book. He told me that the mail clerk had a sick child and that Drew Brees heard about the illness and went to the home to visit the child. This was done out of the earshot of the media with no cameras running. Drew Brees did this because he treats everyone on the team, from the star running backs and wide receivers to the mail man, exactly the same. Drew Brees recognizes that a team consists of all of the members and not just the star players, the patient explained. I would have never had access to that story if I was so busy that that I didn’t take notice of the book he was reading.
Bottom line: So how can we hear the music when a virtuoso in our own backyard, such as in our examination rooms, is playing it? Start by considering each patient having something special that they can share with us. You can only do this when you sit down and be eyeball to eyeball with the patient. If possible, remove any barriers, such as a computer screen, between you and the patient. Don’t spend the majority of your time writing in the chart or using the computer. Think about hiring a scribe to do this for you. Ask the patient about their personal life for just a few seconds before launching into their medical problem. Let them know you think of them as a person—not a cardiovascular or genitourinary system. Ask the patient, “What has been the best thing that happened to you since our last visit?” You will be amazed at their responses and oh, what you can learn! Remember Drew Brees!
