Patients know what they feel.

When a patient comes to us, they are full of their story. They are brimming with ideas, on what is wrong with them and what they want to change.

Often their focus is on discomfort to pass and to regain abilities that feel lost. When they describe the problem, all of the different aspects are ranked according to personal importance, rather then chronology.

This might feel infuriating to us, who typically approache diseases as a run down of symptoms in time.

Where does the conversation go wrong?

Patients know what they feel. When we want to know, what is going on in their bodies, they are the only source we have as doctors. Even when the patient is a child. Only the child themselves knows really, what they feel.

The quality of their description of their symptoms depends on their ability for self reflection, or self insight. However, they might not know the correct , medical diagnosis.

We see frequently errors, when patients try attribute causes to the experienced effects. They regularly mix up coincidences and correlation.

Nevertheless, this doesn’t take away a very important aspect: 

Patients know what they feel.

What is needed here?

As doctors we need to become curious listeners.

In average an adult patient is interrupted after about 15 seconds, when they have just started to tell their story. The time that a child gets to talk for themselves is even shorter, if it is offers the chance to talk for themselves at all.

What is a curious listener?

While patients, know what they feel, as a response to that, we, as doctors, could hold an attitude of curiosity, with guiding questions, aiming to clarifying the problem, understanding the backgrounds, the starting points, the interfering factors and last not least their own priorities.

Helping to describe …

Although, patients know what they feel, they might struggle to describe their sensations.

They will use their language and images, neither medical concepts nor our language. And their ranking of problems will be according to the importance to them on the individual symptom, rather than according to time or cause and effect.

Patients know what they feel and we need to help them to get all the problems into the open.

What is the risk?

There is a risk, that all the different lines of questions like time, triggers, influencing factors, possible causes, and more might become a mere tick-box-exercise. That would miss the plot.

Are you really interested in, what your patient tells you, or are you just aiming to file their story into a specific diagnosis-treatment-pathway box.

Patients know what they feel. 

When the patient doesn’t fit in our box?

When their story of symptoms does not fit into the box, then we might be wrong with the box we have chosen to place them in.

We will never be able to push a square peg through a round hole. Unfortunately, this often happens, when for the sake of efficiency and “time-restrains” we try to convince patients, that they are wrong, with the symptoms they try to describe:

• “It cannot be that painful”
• “This should have helped”
• “Did you apply the treatment thoroughly” 
• “Did it really not improve”

This is “gaslighting” of our patients, and it is more frequent than we acknowledge ourselves.  But: Patients know what they feel. And when they don’t fit the box, it might be the wrong box.

In a nutshell:

Patients know what they feel, we need to learn to listen curiously.

Acknowledge (medical) beliefs

The curse of knowledge

How to start the journey from fear to fun?

It’s not about us