Medical Interviewing or Listening

Dr Shock
July 27, 2009

elderly man crying

As a psychiatrist you get the opportunity to listen to your patients. Especially in psychotherapy you have the privilege of listening and understanding the patient.

As a general practitioner this time is not always given. In The Netherlands most appointments with a GP lasts for 5 to 10 minutes at the most. Here is a story of a Dutch GP practicing in a rural area in the southeast of the Netherlands. It took the patient three sessions exceeding the time limit to disclose a secret from more than 42 years before. His complaints could be classified as depressive disorder. After the first session he was referred for blood test, chest X-ray and electrocardiography. On the second consultation one week later the GP decided to listen. This ended in the patient reading a poem, ‘I wrote a poem, that has to be on my tombstone when I’m dead’.


‘Why always in such a hurry
Why flows my blood so fast
Why all that turbulence
Why was I sometimes so fierce
I long so badly for rest and peace
At times I found this at the shores of the sea
But always the turbulence returned
And everything had to be done in haste
Now, I’ve found my peace
Although leaving hurts me much
Now, I’ve found my peace
Because my turbulence is no more.’

After this revealing and emotional poem they sat both silent for a while, him sobbing.

‘If I write down the story of my life, doctor, I don’t think you’ll want to see me again.’ He nodded seriously as I looked at him. I said: ‘I’m not a judge. I’m here to help people, not to judge them.’ Nothing more was needed, he began to tell his story.

Seemed he had a short lasting sexual relationship with the younger sister of his future wife before his marriage. This sister in law lives in the same village. Patient and his sister in law never discussed it again, never talked about it at family gatherings or birthday parties. They are on good terms with each other.

A week later I saw him sitting in the waiting room, smiling. I invited him to come in. He radiated happiness. He told me he felt very relieved. Very few of his symptoms remained and he felt great. He had not regretted telling me his secret for one moment. We discussed how to continue. He told me that he could go on without help.

No need for antidepressants or psychotherapy. Touching story with a good poem, but probably so exceptional that you can publish it in a peer reviewed journal, what do you think?

ResearchBlogging.org
Lucassen, P. (2009). The man, the poem, the secret☆ Patient Education and Counseling, 75 (2), 147-148 DOI: 10.1016/j.pec.2008.10.011

 

4 Responses to “Medical Interviewing or Listening”

  1. I still vividly remember my first appt with Dr. X, my psychiatrist. I was terrified. I had never seen a psychiatrist before, and I had all these stereotypes stuck in my head. On top of that he was a man and I was sure there was absolutely no way I could tell my feelings to a man given how many fears and difficulties I had had with men in my life then and in the past. I was also terrified that my interview was going to be an interogation.

    Dr. X was so incrediblely calm and gentle. I saw no signs of a paternalistic attitude. He helped me relax and open up with both his demeanor, the way he asked questions and the questions he asked.

    I remember being much more open and forthcoming than I ever expected to be. I walked out of there thinking, How could I have told a person I just met so many intimate details about my life. His interview and therapy skills continue to be the best I have ever experienced.

    Given how much you care about patients, doctors, psychiatry, people and the world in general I suspect you would be, and are,the same way. Great post.

  2. aqua on July 27th, 2009 at 1:41 pm
  3. Mooi! A

  4. arlette wierenga on July 28th, 2009 at 8:54 am
  5. [...] Dr. Shock gives us a remarkable demonstration of why a favorite tactic of covert rationing – strictly limiting the time doctors and patients can spend with each other – can be counterproductive not only to healthcare economics, but also to our humanity. Caution, though – his post contains a poem that even a concrete thinker like DrRich finds quite affecting. [...]

  6. Grand Rounds, Vol. 5.47 - Cost Containment In Healthcare : The Covert Rationing Blog on August 11th, 2009 at 3:40 pm
  7. When I was still practicing Child psychiatry, I was lucky enough to give my patient the time they need. Sometimes a whole afternoon. Sometimes it is my own time. Now, you are not even allowed to give your own time.
    The Cockroach Catcher

  8. Am Ang Zhang on August 11th, 2009 at 11:41 pm
  1. I still vividly remember my first appt with Dr. X, my psychiatrist. I was terrified. I had never seen a psychiatrist before, and I had all these stereotypes stuck in my head. On top of that he was a man and I was sure there was absolutely no way I could tell my feelings to a man given how many fears and difficulties I had had with men in my life then and in the past. I was also terrified that my interview was going to be an interogation.

    Dr. X was so incrediblely calm and gentle. I saw no signs of a paternalistic attitude. He helped me relax and open up with both his demeanor, the way he asked questions and the questions he asked.

    I remember being much more open and forthcoming than I ever expected to be. I walked out of there thinking, How could I have told a person I just met so many intimate details about my life. His interview and therapy skills continue to be the best I have ever experienced.

    Given how much you care about patients, doctors, psychiatry, people and the world in general I suspect you would be, and are,the same way. Great post.

  2. aqua on July 27th, 2009 at 1:41 pm
  3. Mooi! A

  4. arlette wierenga on July 28th, 2009 at 8:54 am
  5. [...] Dr. Shock gives us a remarkable demonstration of why a favorite tactic of covert rationing – strictly limiting the time doctors and patients can spend with each other – can be counterproductive not only to healthcare economics, but also to our humanity. Caution, though – his post contains a poem that even a concrete thinker like DrRich finds quite affecting. [...]

  6. Grand Rounds, Vol. 5.47 - Cost Containment In Healthcare : The Covert Rationing Blog on August 11th, 2009 at 3:40 pm
  7. When I was still practicing Child psychiatry, I was lucky enough to give my patient the time they need. Sometimes a whole afternoon. Sometimes it is my own time. Now, you are not even allowed to give your own time.
    The Cockroach Catcher

  8. Am Ang Zhang on August 11th, 2009 at 11:41 pm
  1. I still vividly remember my first appt with Dr. X, my psychiatrist. I was terrified. I had never seen a psychiatrist before, and I had all these stereotypes stuck in my head. On top of that he was a man and I was sure there was absolutely no way I could tell my feelings to a man given how many fears and difficulties I had had with men in my life then and in the past. I was also terrified that my interview was going to be an interogation.

    Dr. X was so incrediblely calm and gentle. I saw no signs of a paternalistic attitude. He helped me relax and open up with both his demeanor, the way he asked questions and the questions he asked.

    I remember being much more open and forthcoming than I ever expected to be. I walked out of there thinking, How could I have told a person I just met so many intimate details about my life. His interview and therapy skills continue to be the best I have ever experienced.

    Given how much you care about patients, doctors, psychiatry, people and the world in general I suspect you would be, and are,the same way. Great post.

  2. aqua on July 27th, 2009 at 1:41 pm
  3. Mooi! A

  4. arlette wierenga on July 28th, 2009 at 8:54 am
  5. [...] Dr. Shock gives us a remarkable demonstration of why a favorite tactic of covert rationing – strictly limiting the time doctors and patients can spend with each other – can be counterproductive not only to healthcare economics, but also to our humanity. Caution, though – his post contains a poem that even a concrete thinker like DrRich finds quite affecting. [...]

  6. Grand Rounds, Vol. 5.47 - Cost Containment In Healthcare : The Covert Rationing Blog on August 11th, 2009 at 3:40 pm
  7. When I was still practicing Child psychiatry, I was lucky enough to give my patient the time they need. Sometimes a whole afternoon. Sometimes it is my own time. Now, you are not even allowed to give your own time.
    The Cockroach Catcher

  8. Am Ang Zhang on August 11th, 2009 at 11:41 pm
  1. I still vividly remember my first appt with Dr. X, my psychiatrist. I was terrified. I had never seen a psychiatrist before, and I had all these stereotypes stuck in my head. On top of that he was a man and I was sure there was absolutely no way I could tell my feelings to a man given how many fears and difficulties I had had with men in my life then and in the past. I was also terrified that my interview was going to be an interogation.

    Dr. X was so incrediblely calm and gentle. I saw no signs of a paternalistic attitude. He helped me relax and open up with both his demeanor, the way he asked questions and the questions he asked.

    I remember being much more open and forthcoming than I ever expected to be. I walked out of there thinking, How could I have told a person I just met so many intimate details about my life. His interview and therapy skills continue to be the best I have ever experienced.

    Given how much you care about patients, doctors, psychiatry, people and the world in general I suspect you would be, and are,the same way. Great post.

  2. aqua on July 27th, 2009 at 1:41 pm
  3. Mooi! A

  4. arlette wierenga on July 28th, 2009 at 8:54 am
  5. [...] Dr. Shock gives us a remarkable demonstration of why a favorite tactic of covert rationing – strictly limiting the time doctors and patients can spend with each other – can be counterproductive not only to healthcare economics, but also to our humanity. Caution, though – his post contains a poem that even a concrete thinker like DrRich finds quite affecting. [...]

  6. Grand Rounds, Vol. 5.47 - Cost Containment In Healthcare : The Covert Rationing Blog on August 11th, 2009 at 3:40 pm
  7. When I was still practicing Child psychiatry, I was lucky enough to give my patient the time they need. Sometimes a whole afternoon. Sometimes it is my own time. Now, you are not even allowed to give your own time.
    The Cockroach Catcher

  8. Am Ang Zhang on August 11th, 2009 at 11:41 pm

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