Listening is Great, But Sometimes you must Read Between the Lines

     I did tell this story today about listening and asking questions. My patient Deborah (real name from 1982) had injured her big toe joint and was in severe pain. I immediately recommended surgery which I thought was the correct call, but she resisted. For the next 4 months, Deborah and I tried shots, manipulations, casting, all in severe pain. Nothing worked. Deborah finally came in one day and agreed to have surgery. 

     After surgery, where a piece of fractured bone was removed, was all over, and she had completely recovered and was painfree, I was sitting with her one day in Physical Therapy. Then, and not before, I asked her why she had waited so long (as a 30 year old) in severe pain, to have surgery, knowing how much pain she was in. 

    Deborah said she had been afraid of doctors and surgery for a long time. When Deborah was 4, her 2 year old brother went to surgery for an emergency appendectomy, and died on the table. I learned a lesson that day. I had been a good listener, but I did not listen to what was between the lines. So, even though Deborah non-verbally was telling me to go deeper into her story, I was not ready to do so. To make matters worse, Deborah was really afraid of General Anesthesia where you are put asleep. My surgery was with a local block, and she was awake and comfortable. We had never talked about the type of surgery I would be performing, as we attempted some form of conservative treatment. If I had only told her that 4 months before. 

    So, I try to spend as much time with each patient. Listening to every word. Listening to the clues they provide in what they say and don't say. And times, it is what they don't say that is the most important.