The Art of Listening

Friends often are amazed by Heidi Prather’s ability to address large groups of people.

The North American Spine Society’s (NASS) first female president is quite the natural public speaker, thanks to years of practice before music enthusiasts and medical professionals. When pressed for the secret to her superior oratory skills, Prather usually recounts to friends her tenure as a high school musician—a time in which she was required to memorize a concerto for solo competition and perform well enough to “leave the listener with an emotion they like based on how you played.”

“I learned a lot from that, so thanks Mom and Dad for pushing me to do things I didn’t think I could do,” Prather said last month in her farewell speech at NASS’s 30^th Annual Meeting in Chicago, Ill. “This talking stuff is much easier.”

Considerably easier than navigating the U.S. healthcare system these days.

Patient care has become extremely complicated over the last decade with the evolution of evidence-based medicine and increasing regulatory pressures on doctors and medical firms. Focusing solely on patients—and truly listening to them—often is difficult to accomplish amid such radical changes to healthcare, Prather noted.

“We are experiencing one of the biggest changes in the healthcare culture that most of us will experience in our lifetimes. We have more regulations, more reasons why we have to do something a certain way and we need to report more things,” said Prather, who also is the first doctor of osteopathic medicine to serve as NASS president. “But these are the times we are in, and if we don’t keep our eye on  what is really important—the patient—we are going to lose the ball game. Keeping the patient first will always serve us well.”

One of the best ways to keep patients first is through advocacy.

“If we advocate what is best for the patient, we are advocating for our profession. Advocating for the patient to get the best evidence-guided healthcare will serve us individually as spine researchers and healthcare providers. How do we keep the patients first?” she asked.

By listening. Truly listening.

Though they interact regularly with patients, doctors don’t always listen effectively to their patients. To illustrate her point, Prather shared several videos of real patients who experienced a few bumps in their respective roads to recovery. One, a breast cancer survivor named Pam, “didn’t know how to be a patient,” while another—Pro Bowler/St. Louis Rams punter John Hekker—felt lost after sustaining a weightlifting injury that triggered lower back pain and a disc protrusion. Suffering such a debilitating injury prompted Hekker to feel as if he took his “foot off the gas” of his life.

Perhaps the best example, however, came from Carol, a 70-something grandmother, educator and philanthropist who recounted her seven neck surgeries. She experienced complications after two of the procedures, but the outcomes were drastically different: She recovered from one post-surgical complication fairly quickly (with no other issues), and she attributed it to the fact the doctor involved her in the decision-making and continued to be involved in her care, even from Europe. “Carol describes the need for open dialogue not only between the physician and the patient but that the physician openly communicate with other members of the healthcare team. Seems logical,” Prather said during Carol’s video recollection of her ordeal.
 
Carol’s other post-surgical complication didn’t go so smoothly—she began losing her voice and had trouble catching her breath. Yet when she told her healthcare providers about the problems, they reportedly promised to look into the issues once the bandages came off in several days.

“It’s like telling the auto mechanic that you think you  have a slow leak in your tire and his response is, ‘well, drive it around a few more days and we’ll see if you get stranded somewhere with a flat tire.’ It’s likely you won’t think that’s a good idea,” Prather said.

Carol’s more serious complication sent her to the neruo ICU for a week and resulted in vocal cord paralysis (she spent six months in rehabilitation). She eventually recovered and can laugh about the ordeal now, but Prather said the breakdown in communication is more common than most healthcare practitioners realize.

“The inconsistencies in communication frustrated her and more importantly, scared her,” Prather said. “Many patients are not as articulate as Carol but they do try to communicate with us. And as Pam told us, they don’t always know ‘how to be a patient.’ In the setting we work in today with the amount of documentation, peer reviews, reporting that is required, the most crucial communication—that which directly involves the patient—gets lost. We don’t get reimbursed for educating and communicating. We get reimbursed for doing and have increased requirements to document what we do and how we do it. This needs to change.”

“We need to advocate for our patients. They need our expertise and knowledge base as well as our technical skills. By advocating for the patient, we will be advocating for ourselves. It’s a no-brainer. It’s a win-win.”