Doc­tors’ sick­est pa­tients strug­gle to be heard, but the ABC taught me to lis­ten

The Guardian Australia - - Front Page - Ran­jana Sri­vas­tava

When my pa­tient Paul died un­ex­pect­edly, there was an out­pour­ing of grief. He’d con­sid­ered him­self an or­di­nary man but his memo­rial was filled with those who spoke of his self­less­ness, good­will and un­com­mon poise in the face of a ter­mi­nal ill­ness. The fu­neral came and went. The in­surance forms, too. But when­ever I handed over an­other form to his wife, I saw her sor­row and won­dered how to as­suage it. The short an­swer was not much else ex­cept await the con­so­la­tions of time.

Some time later, I was mak­ing a pro­gram for the ABC about the rip­ple ef­fect of can­cer.

When peo­ple face an ill­ness, their nar­ra­tive is all too of­ten taken over by oth­ers but I wanted the ac­tual suf­fer­ers to tell their story. In ap­proach­ing Paul’s wife, I had two in­ten­tions. First, I hoped that, in some small way for her, a sor­row shared might be a sor­row halved. Sec­ond, it was my way of say­ing to Paul that I still re­mem­bered him.

I took a deep breath be­fore call­ing Paul’s wife.

“Do you feel ready to talk about Paul?”

She hes­i­tated.

“It’s the ABC,” I added, not pre­pared to push any more.

“Then I’ll do it.”

I needed two more pa­tients to com­plete the series but never had a chance to go down my list be­cause the first two said yes. It wasn’t the first time I saw that peo­ple had an in­her­ent be­lief that the ABC would treat their sacro­sanct sto­ries with the re­spect they de­served. In­deed, this be­came a re­cur­ring theme and I am glad to say that the pa­tients were never dis­ap­pointed and of­ten thrilled. After all, where else would an Afghan refugee, an In­dian mi­grant and a Su­danese teacher find free ex­pres­sion?

Amid news of the roil­ing con­tro­ver­sies em­brac­ing the na­tional broad­caster, I have felt much sad­ness for, and sol­i­dar­ity with, the staff I have been for­tu­nate to know. They have taught me some in­valu­able skills along the way.

Bed­side medicine, af­fect­ing change one pa­tient at a time, con­tains great mean­ing but I have also yearned to democra­tise medicine. If the doc­tor-pa­tient re­la­tion­ship lies at the heart of good medicine, doc­tors must pub­licly cham­pion hu­man­ity, ethics and pro­fes­sion­al­ism on be­half of all peo­ple be­fore they be­come our pa­tients. I wanted to tell sto­ries be­cause we live and learn through sto­ries. This is why sev­eral years ago I went to the ABC, look­ing for di­rec­tion and guid­ance, armed with noth­ing more than ideas. I was not seek­ing a job but look­ing for a plat­form. I was a mi­grant, the lucky re­cip­i­ent of an Aus­tralian med­i­cal ed­u­ca­tion, but I had no clever con­nec­tions, no pub­lic pro­file and no me­dia ex­pe­ri­ence. I ex­pected noth­ing but re­ceived more than I had ever imag­ined.

For a start, nearly ev­ery sin­gle per­son, from top to bot­tom, whom I wrote to ac­tu­ally re­sponded. One prom­i­nent jour­nal­ist be­gan with apol­o­gis­ing for the de­lay in for­mu­lat­ing a mean­ing­ful re­sponse. An­other in­tro­duced me to the then ed­i­tor of Guardian Aus­tralia. Sec­onds be­fore go­ing live, a pre­sen­ter calmed my nerves. An­other helped me pre­pare for my first few pub­lic events. Pro­duc­ers, re­searchers and cam­era op­er­a­tors all found time. They made me prac­tise till I protested that medicine was easier, and gave me lessons on ex­pres­sion, con­tent and avoid­ing mis­ad­ven­tures with a live mi­cro­phone. They were un­stint­ing in their good­will even as they were squeezed for re­sources and their own fu­ture was in doubt. And their sin­cer­ity and sen­si­tiv­ity to­wards my most vul­ner­a­ble pa­tients never failed to move me. As an out­sider, it was re­mark­able for me to wit­ness how these peo­ple cared not just about sto­ries but the peo­ple who told them.

These days, I am an oc­ca­sional co­host on the Con­ver­sa­tion Hour with Jon Faine.

On the show, I have an op­por­tu­nity to can­vas im­por­tant health­care is­sues such as lone­li­ness and care­giver stress and also in­ter­view guests who range from au­thors and so­pra­nos to co­me­di­ans and coun­sel­lors and ev­ery­one in be­tween. As an on­col­o­gist, my ca­reer re­volves around ex­tract­ing sto­ries from strangers but, of course, medicine has its own way of do­ing this. It’s called tak­ing a his­tory and in­volves rapid-fire ques­tions. How would you rate your pain? Why didn’t you take your pills? What did the sur­geon say? How much do you smoke? When was your last scan? Un­for­tu­nately, far too many his­to­ries ig­nore the hap­less pa­tient, with the av­er­age doc­tor in­ter­rupt­ing within 20 sec­onds.

The most im­por­tant skill I have learnt at the ABC is how to lis­ten. Like ev­ery novice in­ter­viewer, I started by rack­ing my brains for what to say next so as to not sound clue­less on live ra­dio. But then, there was noth­ing more grat­ing than a missed in­sight while I wan­dered the cor­ri­dors of my own brain. Through a lot of watch­ing and learn­ing, I re­alised that if you pay at­ten­tion to a con­ver­sa­tion, the rest will come. In fact, this un­der­stand­ing has been my sav­ing grace as a doc­tor. All too of­ten, my sick­est pa­tients are re­ceiv­ing the right drugs but they strug­gle to be heard. The ma­jor­ity of health­care com­plaints in­volve a fail­ure of com­mu­ni­ca­tion. Mak­ing pa­tients feel as if their story is the only thing that mat­ters in what­ever time we have is in­te­gral to good medicine and it un­cov­ers clues that might oth­er­wise have been eas­ily missed. Cyn­ics might ask where the time is to lis­ten amid the trap­pings of modern medicine but, even as a mat­ter of ex­pe­di­ency, a heard pa­tient is a sat­is­fied cus­tomer.

Re­cent events and the dis­mayed pub­lic re­ac­tion have un­der­scored the im­por­tant role the ABC plays in the lives of mil­lions of Aus­tralians. I could never have pre­dicted it but it has cer­tainly shaped my life and al­lowed me to af­fect the lives of my pa­tients. Not too many doc­tors are taught by jour­nal­ists but I will hap­pily ad­mit that the peo­ple of the ABC have filled in some im­por­tant gaps in my ed­u­ca­tion. It turns out that the ABC en­riches so­ci­ety in some un­com­mon ways, which is why I sin­cerely hope it finds its feet and con­tin­ues to up­hold its fine tra­di­tion.

When peo­ple face an ill­ness, their nar­ra­tive is all too of­ten taken over by oth­ers.

Pho­to­graph: Peter Byrne/PA

The ma­jor­ity of health­care com­plaints in­volve a fail­ure of com­mu­ni­ca­tion.

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