Medical

When Doctors Listen: A Conversation with Dr. Leana Wen

Dr. Leana Wen was on a roll. The Washington University medical student was president of the American Medical Student Association, and was thoroughly enjoying her training. Then, her mother fell ill, and she found herself on the other end of the health care system.
“My mother was misdiagnosed for over a year before she was diagnosed with metastatic breast cancer… I was her caregiver for eight years, and saw the disconnect between what patients really need and what medicine is actually doing,” she told Student Doctor Network, after presenting at the UC Davis Pre Health Conference.
This was a formative experience for the young doctor, who went on to pursue emergency medicine. Her journey as a caregiver and her firsthand knowledge of medicine led her to write a book, When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests (St. Martin’s Press, January 2013; paperback June 2014).
“I wanted to write this book to share these lessons and these stories, to help patients know what are the things they can do when they’re asking for help, and at the same time, what are the things that we in medicine do to foster that,” she says.
Wen admits to being nervous about the reaction of her physician peers to the publication of such a potentially controversial title. “I mean, when you write a book called ‘When Doctors Don’t Listen’, what are other doctors going to think?” It turned out that many doctors assumed Wen wasn’t referring to their own listening skills, and approached the book with a “ ‘it’s not me it’s you’ mentality – other doctors may not listen, but I do.” But others were extremely receptive.
“I think that most (physicians) do recognize the importance of listening, the importance of humanism and basic respect, and that we have these problems together; that we need a partnership between doctors and patients in order to make our system humane, and (provide the) best possible situation for our patients.”
Wen currently teaches at her alma mater, Washington University. “I’m an optimist, and I believe that students who are entering medicine understand the importance of showing people respect and serving communities,” she said. “But I’m not sure this level of humanism is fostered during our medical training. That’s why I’m a medical educator. I teach students and residents every day about the importance of humanism, and that ultimately its not about seeing patients as diseases, but treating them as they are, and how we would want our loved ones to be treated.”
The former Rhodes scholar chose emergency medicine as her specialty due to her passion for patient-centered care. “I wanted to be able to treat every patient who came my way – no matter their age, their ability to pay,” Wen says. “My favorite part of the job is treating patients who, otherwise, might have been turned away. We see them at their worst – on drugs, having issues with violence, and my job is to treat them with humanism and respect and the dignity that they deserve.”
Wen believes emergency medicine is a fantastic career for those who not only treat patients with respect, but who are also comfortable with risk. “We have to make very quick decisions, with very little information. These are not patients who we’ve known for a long time. And we’re not focused on one body part, so we have to take into account the entire picture, with limited information about that picture, and make a good decision very quickly,” she says.
“Emergency physicians have to have a high tolerance for different types of input at the same time – we need to be good multi-taskers and be able to understand many different points of views, and we can’t just be attentive to the patient in front of us, but also the 10 patients, the 50 patients who are also waiting for our attention as well,” Wen continues.
“And the most important thing about being an emergency physician is that we need to know about public health, because we are the front door of the hospital. We see diseases and epidemics before they become epidemics. We see the worst issues of society, but we also have to figure out what is it that will help them become healthier people. Someone comes in with a gunshot wound, isn’t just necessarily a victim – they may also be a perpetrator of violence. And we have to help them break that cycle of violence. Someone coming in with an asthma attack doesn’t just need an inhaler, they also need to know how to stop smoking, and what are the things they can do to enhance their health.”
For students planning on entering the medical field, Wen offers some sage advice to ensure that they keep humanism as a central focus of their practice: think back to the last time a friend went through a tough breakup.
“It is natural for people to listen, and we all know how to listen to that story,” she explains. “In the same way, most of us know how to listen to someone’s story about their abdominal pain and the issues they faced getting medical care. I actually think this is intuitive to us, when I look at first year medical students – they do very good at listening, even when they don’t know what they’re supposed to be asking. And I think we need to get back to that focus of who we are – we are ultimately people – and learn how to communicate not just as the doctor here, and the patient here, but as people who are equal partners in healthcare.”
Lastly, she says, medical students need to make sure they are listening to their own instincts, needs and desires. “Know your mission, your story, your drive. In order to weather the criticisms, weather the challenges (of medical education)… that’s absolutely critical.”
Since the writing of this article, Dr. Wen has started a new job as Health Commissioner of Baltimore City.

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Suzanne Barston is a Chicago-based writer and journalist specializing in the areas of healthcare and science.