Patient Listening: A Doctor's Guide
by Loreen Herwaldt
Review by Vincent J Felitti, MD, FACP
Fall 2008 - Volume 12 Number 4
That this is an unusual book is immediately suggested by the triple entendre of its title. That it is clinically useful and interesting requires dipping into the text, which is largely rendered in the cadence and typographic layout of poetry. This turns out to be a surprisingly helpful device, perhaps because it slows us down enough to improve our understanding—the way work songs once organized and improved effort by creating a sense of relationship. After all, poetry is a highly efficient way of transferring understanding from the unconscious of one person to that of another, using rhythm, rhyme, and allusion—usually bypassing conscious resistance when well done.
Loreen Herwaldt, MD, is an internist who is deeply engaged in trying to improve medical practice through what has become known as Narrative Medicine. Although the medical history is clearly the most important component of our diagnostic triad of history, physical examination, and laboratory studies, we all know it is often given short shrift because of time, inexperience, and discomfort. Narrative Medicine is that process, even involving the world-famous Writer’s Workshop at the University of Iowa, that supports eliciting and understanding a patient’s history. It is this variation on a basic theme that, in addition to understanding our patients to be more than bearers of a disease, lets us see our own feelings, unexpectedly, quickly, and without too much pain.
The patients whose stories are abbreviated and reformatted in this book are a diverse group including some famous physicians writing of their own personal experiences with disease and treatment. Interestingly, the physicians are often critical of the frequent lack of humanity in the care they received. It is not a happy picture they paint of being on the receiving end of medical practice, but they make this clear in a way that is somehow acceptable. Unexpectedly, I even learned some interesting biomedical information about retinal detachment and intermittent intestinal obstruction. The vivid descriptions elicited by the process of this book made that learning far more memorable and gratifying than reading it in medical texts.
Narrative Medicine turns out to be code for relationships, the often-missing piece that underlies so much physician unhappiness. Don’t look away. Get this book.