What Patients Say, What Doctors Hear

Book Title: What Patients Say, What Doctors Hear

Book Author: Danielle Ofri

Publication Information: Boston, Beacon Press, 2017, 242 pp., $24.95, hardcover

Through her own transparent self-disclosure and interviews with patients and physicians, Dr Danielle Ofri distills the dissonance between what patients say and physicians hear. In this book, Dr Ofri, an internal medicine physician in New York City, further extends her writing career on medicine and empathy. Family physicians will hear echoes of their own patients in these stories: the persistent patient who drops by unscheduled at lunch, the patient with type 2 diabetes who struggles to fit self-care into an already crowded life, the complex chronic patient who wants to drive the plan of care rather than rely on a primary care manager. She challenges physician assumptions and demonstrates the patient perspective.

Dr Ofri weaves in glimpses of theory and evidence, but at its heart, this book is a celebration of the physician and patient story. Little of what Dr Ofri writes will be novel to readers in family medicine. However, her voice reminds and reinforces the careful practice of listening. She emphasizes that medical communication is not only information transfer, but also a carefully woven tapestry of information, empathy, and connection.

Much of the value Dr Ofri imparts is her voice. She posits that physicians do not value the “less-tangible components of medicine—communication, connection, and empathy” because they are both harder to measure and less typically taught in medical education. But she claims those biases for herself. She argues that before physicians can overcome any sort of bias, they must be honest about it. Through the transparency of this book’s narratives, she makes great strides toward that goal herself.

Her narrative argues that we should move from a patient-centered to a person-centered approach, in which we recognize each patient as an individual person. Hidden within the detailed stories are smart tactics to improve physician-patient communication, such as recommending that patients take notes if they like, or avoid the patient-critical jargon of medicine (“patient refused treatment” or “the patient expired”).

Dr Ofri attempts to answer bigger physician-patient communication questions such as “Does disclosure increase solidarity?”, “How is physician communication as, if not more, effective than placebo?”, “How should physicians frame recommendations?”, “Should they adhere to equipoise or raise expectations?” In response to each of these questions, she presents a balance of cited research and experience that demonstrate how physician-patient communication is not a predictable interaction that can be addressed with an algorithm. She shows how communication is an art in which physicians must consider the context and the individual patient in each encounter.

In the end, Dr Ofri’s book is an ode to teamwork between the physician and patient. As with any successful team, the key to effectiveness is trust built on careful communication. This book provides family medicine physicians and faculty useful content to create discussion points and vignettes for teaching students and residents the finer points of interpersonal and interprofessional communication. Family medicine physicians may also draw validation and additional inspiration for how they communicate with their own patients.