Synapse, Simply Listening, Abigail Cutler

Simply Listening
by Abigail Cutler ::: bio

Dr. Lawrence Cutler, Chief of Medical Service at Eastern Maine Medical Center in Bangor from 1948-1968, was known for his remarkable bedside manner — a reflection less of his communication skills than his habit of visiting his patients’ actual bedsides. It was not uncommon for my grandfather to get up in the middle of the night and drive hours across the expanse of the state to make a house call. (Once, after hours of late-night driving, he found himself hopelessly lost and realized, to his surprise, he had driven well into Canada.) Like most general practitioners, my grandfather knew his patients well — not because he asked pointed questions about their cultural, religious or economic backgrounds, but because he took a natural interest in their lives — and was able to take the time to visit them at home.

A lot has changed in forty years. In today’s health care regime, with third-party payers allotting time in tiny increments, health care professionals struggle to find time to listen to their patients. They have become increasingly frustrated with their profession, and patients have come to feel increasingly neglected. My mother, a third-year psychiatry resident, cannot learn more about her patients by making house calls: her patients must come to her. Generally, each patient is allotted less than half an hour to meet with her, a situation she finds frustrating. “Twenty minutes is barely sufficient to greet the patient and let him relax enough to report how things are going, much less to discuss any difficult issues that may have arisen since the last visit, adjust medications, write prescriptions, scramble around the office rounding up samples and make any needed referrals,” she told me in our interview. “I often feel robotic and the most important part of the encounter — empathic listening, unburdened by the need to multitask — suffers.”

Even as time with patients is being cut, the demands on health care professionals are increasing. To be a good health care provider today is to keep current with technological advances to provide patients with better care. Most health care professionals receive (and sometimes even find time to read) a bewildering array of medical journals each week, but keeping up with technological and scientific developments in medicine is not enough. A good health care provider must educate and re-educate herself about her patients’ perspectives as well as their bodies. For just as the practice of medicine has become more complex, so has today’s patient population. Health care professionals now face a growing number of patients whose needs and backgrounds — cultural, economic, educational, or religious — differ from their own. That’s why last year over 1500 health care professionals across the country added novels, short stories, poems, and plays to their professional reading in an effort to expand and deepen their understanding of their patients, colleagues, and themselves. In the process, they often re-discovered what it was that brought them into health care to begin with.

Literature & Medicine: Humanities at the Heart of Health Care®, piloted at Eastern Maine Medical Center in 1997, is a facilitated, hospital-based reading and discussion seminar for mixed groups of healthcare professionals. The seminars take place over a five to six-month period during which participants gather one evening a month — often over dinner — to discuss readings selected by their facilitator. The readings vary from group to group because facilitators choose their own syllabi, often based on — though not limited to — a larger list of readings recommended by the Maine Humanities Council. The readings present a variety of viewpoints and deal — either directly or more subtly — with issues that those who choose to attend the seminars face every day in their work. The program has reached 25 of Maine’s 38 hospitals, and has successfully traveled to health care facilities throughout New England, as well as to Illinois and Utah. Each Literature & Medicine group is organized by a hospital liaison and led by a scholar/facilitator, both of whom receive training provided by the Maine Humanities Council through training institutes and their state humanities council.

“[Literature & Medicine: Humanities at the Heart of Health Care®] is a project extraordinarily strong in its humanities content and brilliantly simple in its premise: that the humanities can bridge enormous distances among people who, while working in the same physical space, may be separated by significant professional, economic and educational barriers,” said the judges who awarded the project the 2003 Helen and Martin Schwartz Prize for Excellence in Public Programming. To be sure, the program is “simple.” It is so simple, in fact, that many health care providers and administrators are initially skeptical about the benefits of a program that aims to teach (or re-teach) them how to communicate with their patients and colleagues. After all, what could be simpler than having a conversation? But simply having a conversation, much less a difficult conversation, can be harder than it seems due to the complexity of relationships existing between health care professionals and their patients and colleagues. According to last year’s Literature & Medicine participants, the seminars help them think about their work, and see their patients and colleagues, in new ways.

A nurse from Southern Maine Medical Center described how refreshing it was “to talk to [physicians] in a neutral context, removed from the usual physician-nurse relationship and dialogue.” An administrator from Rhode Island Hospital attributed her enjoyment of the program to “the intelligent and interesting exchange of fellow workers in the hospital” and mentioned how the program has both enhanced her enjoyment of books and “increased her appreciation for the health care work of others” — including her husband, a retired professional from the State Health Department. “The most valuable part is working with many professions, different ages, and different types of people,” said a University of Massachusetts medical student, adding, “[The program] renewed my interest in medicine [and] my ability to enjoy reading and thinking.” Other participants agree. “The seminars were a wonderful opportunity to discuss topics with people I may not normally have done that with. I liked hearing everyone’s different opinions and interpretations,” wrote one nurse. “I liked listening to what people brought from their background and their life experiences... [The seminars are] a great way of continuing education, broadening horizons and appreciating diversity.” Another nurse wrote that “[The seminars] made me realize the richness of my training and how my being a nurse has shaped my dealings with all — from patients to family.”

A facilitator from Vermont emphasized the importance of choosing a syllabus that generates valuable discussion and noted that the most successful texts were almost always those that elicited strong, often differing opinions. A health care worker at Dartmouth-Hitchcock Hospital agreed with the observation. “It brought out very different opinions,” she said of the play, W;t. “[And yet], everyone was amazingly tolerant of each others’ reactions and perspectives.” Most participants appreciated how the program (and the readings) encouraged them to disagree and to challenge each other, and that they were able to share their views “in such a non-threatening manner.” Some spoke in intimate detail of how the program had improved their professional — as well as their personal — lives.

One participant’s story especially seemed to capture the essence of Literature & Medicine. Like many participants, this physician found his group to be simultaneously supportive and challenging. He recounted a particularly memorable session in which the group discussed Belle Waring’s poem, “Euthanasia”:

Having already gone through a real-life experience with euthanasia and my father, I had strong — and of course controversial — opinions on the subject. Although many of my colleagues and fellow participants disagreed with both my beliefs and my actions, in the seminar we were all fellow health care professionals — some of us were fellow sons and even fellow Catholics. We all had to listen to each other — they had to listen to me. That session was truly important for me as a doctor and as a father’s son. Talking through the issue not only helped soften my conscience, but it brought me closer to my colleagues. And now, when I am faced with end-of-life issues in my medical practice, I can speak for all sides and not just my own.

By doing something as “simple” as talking through a difficult issue with his colleagues within the safe environment created by the facilitator, and with readings to help frame the discussion, this physician developed closer relationships with his co-workers and a better understanding of the beliefs associated with a very controversial yet common medical dilemma. That particular session may not have changed the way every participant practices medicine, but it is clear that everyone learned something new (and valuable) that day, simply by sharing perspectives and respectfully listening to one another.

In its simplest terms, Literature & Medicine offers health care professionals an opportunity to connect and reflect with each other using the medium of literature. It also improves communication among co-workers, offers colleagues an opportunity to interact with one another in a meaningful way away from their work environment, and helps to break through the professional hierarchies within the hospital setting. It even gives professionals a chance to rediscover why they came into the profession in the first place. As one participant wrote, “This seminar has helped me to clarify in the hugest sense why I am a social worker. What more could anyone want?” And most remarkably, Literature & Medicine has proved to be an innovative and cost-effective way of improving health care. By offering health care professionals the occasion to examine the nature and importance of their relationships with patients, the program broadens their ability to work well with a diverse range of patients. Literature & Medicine reminds health care professionals that their strength lies in their consistent ability to provide good care to all kinds of patients, and that understanding a diverse array of perspectives is therefore absolutely necessary. And while some health care professionals may feel initially skeptical about a program that asks them to spend extra time in the hospital to participate in Literature & Medicine discussions, every Literature & Medicine participant has come away from the sessions knowing that there is always more to be learned. “[Our] discussions have significantly reordered how I think about medicine,” wrote one physician. “I live with the experience of the protagonist in one of William Carlos William’s Doctor’s Stories, a physician who acted without listening. I do not want to be like him. I am learning to sit quietly and listen.” Literature & Medicine may not be the perfect remedy for all the problems in today’s health care system, but it may be able to produce a generation of happier patients and providers.

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Literature & Medicine has received major support from the National Endowment for the Humanities.