My Six Cents: How to Help a Patient Feel Seen & Heard

Compassion, clear communication, open questions, active listening, empathy. These are bedside manner buzz words we all learned in medical school. The American Medical Association Code of Medical Ethics includes an entire section detailing the ideal patient–physician relationship, as do similar documents from other respected bodies, such as the Royal College of Physicians. And if you ask ChatGPT, “How to be a good doctor with good bedside manner,” it will list similar aspirational qualities.

We know what we’re supposed to do, and the tenets of bedside manner are well-defined. So why then aren’t all doctors empathic and thoughtful communicators? What fosters a patient encounter in which the patient feels seen and heard, and what makes an otherwise identical visit go terribly wrong?

I am not sure. But I have opinions, and I have tips.

Who Am I?

Samantha C. Shapiro, MD

Hi. I’m Sam. I’m a consultative rheumatologist and clinical educator. For a living, I see patients for second opinions. I spend time with their records and hold space for them to tell their stories. I educate them and answer their questions. Then, I offer recommendations they can discuss with their treating physicians.

How did I get here? The short story: After years in academics, I burned out, did a lot of deep interpersonal work and reinvented my life. The long story is an article for another time.

A lot of the patients I see are undiagnosed. They have years-long, 1,000-plus-page, medical records. They’ve seen multiple specialists and, often, multiple rheumatologists. They’re searching for answers, haven’t found any yet and just want to feel better. And I help them do that.

Do patients like these sound familiar? Of course they do. As rheumatologists, this is—like it or not—what we signed up for. Despite years of experience with such patients, a part of me always worries that they’ll be disappointed when I don’t come up with some sort of magic solution for them—because I’m not magic.

However, what I have realized is that the magic doesn’t lie in my ability to diagnose and treat a patient. Rather, the magic lies in my ability to help a patient feel seen, heard and understood. The magic lies in holding their hand as they tread through a room that has been dark for a long time and letting in a crack of light.

Admittedly, the amount of time I spend with my patients is a luxury most physicians don’t have and indubitably explains some of my success. But I don’t think that’s all there is to it.

I write this article for you—my colleagues—to share tips from my personal, subjective experience. My hope is that one of these may change the way you relate to your patients and, in turn, enhance one or both of your experiences.

My Six Cents

1. Start with the Social History
As soon as a patient sets foot in a clinic, most hear some version of “Why are you here?” They learn quickly that their chief complaint takes precedence over everything else. But patients are human beings with lives outside the hospital, and curiosity creates the safety needed for them to express themselves openly and honestly.

Instead, I start with “Where’d you grow up?” And if the patient looks confused or defaults to talking about their joint pain, kindly redirect. “We’ll have plenty of time to chat about medical stuff,” I say. “First, I just want to get to know you a bit.”

Ask about family. Ask them how they spend their time and what they like to do for fun. If you like that stuff too, share. Doctors are human beings with lives outside the hospital, too.

2. Invite the Patient to Tell Their Story from the Beginning
When you get to the medical stuff, the most important question still is not, “Why are you here?” Rather, it’s “When is the last time you felt 100% well?”

Many patients will remark that that was a long time ago. Your response? “That’s okay. Start at the beginning and walk me through what’s been happening in your body in the order that you experienced it. I’ll type, listen and save my questions until the end.”

Then, put your money where your mouth is. The details that crack the case may precede the symptoms the patient otherwise would’ve recounted first. But even if they don’t, allowing a patient to tell their story from start to finish—without interruption—helps them feel seen and heard, even if the visit doesn’t end with a diagnosis.

3. Leave Asterisks in the History of Present Illness
When you’re tempted to interrupt the patient to ask for clarifying information, don’t. Simply leave a little asterisk in the history of present illness as a placeholder to come back to when it’s your turn to speak and fill in the blanks at that time.

4. Lead with Curiosity
We all encounter patients who need medications but don’t want to take them. It’s frustrating, but frustration—or worse, contempt—won’t get you very far.

Get curious about what’s in the way of the patient taking medication. Ask them if they’d be willing to share what’s coming up for them when they think about those medications. You may be surprised what you learn.

5. Ask for Consent
After you’ve figured out what’s in the patient’s way, validate their perspective, and ask for permission to share yours.

Try saying something like “I understand why that’s concerning for you. Thank you for sharing and helping me better understand where you’re coming from. Would you be open to hearing my thoughts on this? I care about you and your health and simply want to make sure you are armed with all the information you need to make the decision that feels best to you.”

You’d be surprised how many patients’ minds I have changed with this approach. People are a lot more likely to listen and take your advice when given the choice of doing so.

6. Stay Heart Centered
This tip is a no-brainer, but it needs to be said. When a patient isn’t getting better, care, express concern and inspire hope. That’s it.

I often conclude visits by saying, “I know you haven’t felt well for a long time, and I’m sorry. But I truly believe there is a day in the future when you can feel better than you feel now.”

And patients like this conclusion because I mean it when I say it.

Thanks

If you’ve made it this far into my article, thank you. Whether you choose to incorporate these tips into your practice or not, I appreciate you, and your patients do, too.

Samantha C. Shapiro, MD, is a clinician educator who is passionate about the care and education of rheumatology patients. She writes for both medical and lay audiences and practices telerheumatology.