Speaker 1: Hi, I'm Aaron Welsh and this is this podcast will
Speaker 1: Kill You. You are listening to the latest episode in our
Speaker 1: special series we're calling the tpw k Y Book Club.
Speaker 1: This isn't your typical book club where you spend about
Speaker 1: ten percent of the time talking about the actual book
Speaker 1: selection and the other ninety percent eating tasty snacks and
Speaker 1: drinking tasty drinks and talking about a million other things,
Speaker 1: which I absolutely love. By the way, shout out to
Speaker 1: my real life book club. In the TPWKY book Club,
Speaker 1: which I also adore. We're staying on topic, getting to
Speaker 1: hear directly from the authors themselves about what inspires them,
Speaker 1: how writing change their outlook, what they most want people
Speaker 1: to take away from their book, and so much more.
Speaker 1: So far this season, we've explored books on topics ranging
Speaker 1: across the fields of medicine, science, and history, and there
Speaker 1: is still so much more to come. If you'd like
Speaker 1: to check out the full list of books we've covered
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Speaker 1: booklists covering everything podcast related, including a book club list
Speaker 1: where you can see all of the books featured in
Speaker 1: these book club episodes. And one last thing before we
Speaker 1: get into the book of the week, that is to
Speaker 1: please rate review Subscribe really helps us out so much,
Speaker 1: and also share your thoughts with us. We always love
Speaker 1: to hear from you. Think of the last time you
Speaker 1: spoke with a doctor about a concern that you had.
Speaker 1: How long did the doctor spend with you. Do you
Speaker 1: feel like they were present in the room or did
Speaker 1: they seem distracted checking emails, typing up notes with half
Speaker 1: a mind on the conversation. Did you get all of
Speaker 1: your questions answered? Did the doctor give you time to
Speaker 1: ask questions? How did you feel at the end of
Speaker 1: the appointment. Did you feel listened to, understood, cared after,
Speaker 1: reassured or did you feel gas lit, condescended to dismissed, unheard.
Speaker 1: Hopefully your experience falls into the first category of emotions,
Speaker 1: but I know that many, if not all, of you, have,
Speaker 1: at some point or another, been made to feel the latter.
Speaker 1: Going to a doctor's appointment, whether for a routine checkup
Speaker 1: or a specific prim problem or concern, can be a
Speaker 1: very vulnerable experience. It's no exaggeration to say that you
Speaker 1: are putting your life and health into their hands, and
Speaker 1: when that trust is broken, the damage can be severe,
Speaker 1: both in the short as well as the long term.
Speaker 1: What is it about the physician patient relationship and the
Speaker 1: way that medicine is practiced today that lends itself to
Speaker 1: this pattern of dismissal. That's exactly what doctor Ragastri Darowan
Speaker 1: explores and unheard the medical practice of silencing. Doctor Darrewan,
Speaker 1: who is a sexual health and HIV doctor with the
Speaker 1: NHS as well as a health equity researcher and science communicator,
Speaker 1: draws upon her own experience as both patient and physician
Speaker 1: to examine this nuanced topic from multiple perspectives. Through her research,
Speaker 1: she demonstrates that this problem of silencing patients is not
Speaker 1: a matter of a few doctors acting negligent or being
Speaker 1: too exhausted to properly listen, but rather a systemic issue
Speaker 1: in medicine, where the foundations of patient dismissal are laid
Speaker 1: out during medical school training and perpetuated by the medical system,
Speaker 1: and as minoritized groups are disproportionately more likely to be
Speaker 1: silenced by their health care providers. They are also more
Speaker 1: likely to suffer the negative health consequences that being unheard
Speaker 1: carries with it. Compounding this are the knowledge gaps that
Speaker 1: tend to be wider for conditions primarily impacting minoritized groups,
Speaker 1: a reflection of research priorities that designate funding and resources
Speaker 1: to more prestigious diseases. To say this matter is complex
Speaker 1: is an understatement in the extreme. Fortunately, doctor Derrewan's clear
Speaker 1: and compassionate approach in Unheard expertly guides readers through the
Speaker 1: factors enabling the continued silencing of patients and crucially suggests
Speaker 1: how positive change can be made by individuals during training
Speaker 1: at an institutional level and at a systemic level. I
Speaker 1: truly loved this book and this conversation for getting to
Speaker 1: the heart of this issue, for exploring not just why
Speaker 1: does it happen, but also providing a roadmap for how
Speaker 1: it can get better. And I am so excited to
Speaker 1: share this conversation with you all. So let's get into it,
Speaker 1: Doctor Darwan. I'd like to just first thank you so
Speaker 1: much for chatting with me today. Welcome to this podcast
Speaker 1: Will Kill You book Club.
Speaker 2: Thank you so much for the invites and I'm really
Speaker 2: really excited to be here.
Speaker 1: Your book, Unheard the Medical Practice of Silencing was a
Speaker 1: truly compelling blend of infuriating and enlightening, and I suspect
Speaker 1: that it will resid with many many people. I also
Speaker 1: think it should probably be required reading for medical practitioners
Speaker 1: as a part of both initial and continued training. Can
Speaker 1: you describe your journey to writing this book and how
Speaker 1: your experience on both sides of the power dynamic as
Speaker 1: both physician and patient influenced the approach that you took.
Speaker 2: So, I think it's been coming for a really long
Speaker 2: time and kind of this year is my twentieth year
Speaker 2: of being a doctor, so you know, probably all of
Speaker 2: my career it's been coming. And my work, my day
Speaker 2: work is I work in sexual health and HIV, so
Speaker 2: I work with some really kind of minoritized patients who
Speaker 2: are people who aren't heard generally in policy, who you know,
Speaker 2: who are often very poor, they have HIV stigmatizing disease.
Speaker 2: So part of that is my work with them, I think.
Speaker 3: But what really.
Speaker 2: Instigated the book were my experiences as being a patient.
Speaker 2: So I was diagnosed with endometriosis when I was trying
Speaker 2: to get pregnant, which was unsuccessful, and kind of went
Speaker 2: on to have fertility treatment. And during one of those
Speaker 2: fertility cycles, I was on a lot of hormones and
Speaker 2: I developed really really bad abdominal pain, like excruciating pain,
Speaker 2: the worst I'd ever had. So my husband took me
Speaker 2: to the emergency department. Initially I was seen, I was given,
Speaker 2: you know, really strong painkillers, and then I was admitted
Speaker 2: to the ward and they were really worried that I
Speaker 2: had this thing called ovarian torsion, which is when the
Speaker 2: ovary is so big from the hormonal stimulation that it
Speaker 2: twists on itself and you need urgent surgery. But a
Speaker 2: scan showed I didn't, but I was still in a
Speaker 2: lot of pain, which I thought was due to kind
Speaker 2: of a flare up with the endometriosis.
Speaker 3: From the hormones.
Speaker 2: And whilst on the ward, I asked for more pain relief,
Speaker 2: but I refused it. Basically the medical team didn't seem
Speaker 2: to believe that I was in so much pain. They
Speaker 2: treated me like I was just trying to get morphine
Speaker 2: because I wanted it, and it was a really shocking
Speaker 2: experience for me. At that point, I'd been a doctor
Speaker 2: for quite a long time senior, and I just thought,
Speaker 2: you know, if this could happen to me, this experience
Speaker 2: of being disbelieved when asking for pain relief, what on
Speaker 2: earth happens to everybody else? And in the end, I needed,
Speaker 2: you know, my partner to advocate for me. I thought,
Speaker 2: you know, what if you can't speak English, what if
Speaker 2: you don't have a partner. I know how the healthcare
Speaker 2: system works. What if you don't know how it works?
Speaker 2: What happens to everyone else? So that was really what
Speaker 2: instigated it. And also the fact that at the time
Speaker 2: I didn't complain, and I didn't complain afterwards either. I
Speaker 2: felt really ashamed and I felt silenced for quite a
Speaker 2: long time. And it wasn't until kind of maybe six
Speaker 2: or seven years later that I started to do some
Speaker 2: writing and I ended up writing about this and really
Speaker 2: reflecting on why did I feel so silenced? And this
Speaker 2: really came together into the book. But also the factor,
Speaker 2: you know, I'm a patient, but I'm a doctor patient,
Speaker 2: so I'm not just any old patient. And I'm a
Speaker 2: doctor and I know very well that despite my best.
Speaker 3: Intentions, I don't always listen well.
Speaker 2: And you know, much as I love to say that
Speaker 2: every single patient I've seen will say they had the
Speaker 2: best experience with me.
Speaker 3: That's probably not true.
Speaker 2: So I thought the book was a really good opportunity
Speaker 2: to look at why we don't listen and who doesn't
Speaker 2: get listened to.
Speaker 1: In your book, you use the terms deliberately silenced and
Speaker 1: preferably unheard to describe those patients who are ignored by
Speaker 1: medical practitioners. Who are those individuals most likely to be
Speaker 1: and what does being silenced or unheard look like? Because
Speaker 1: it can be a great many things, sometimes maybe not
Speaker 1: as obvious as just like thinking about, oh, someone is
Speaker 1: going I don't believe you like that is not often
Speaker 1: how it comes out.
Speaker 2: I think when I started the book, I thought it
Speaker 2: was just some people who go unheard, But during my
Speaker 2: research I actually found out that actually all patients go unheard.
Speaker 2: And I'm sure we'll talk more about why that is.
Speaker 2: But obviously some patients go more unheard than others. And
Speaker 2: these are often people from minoritized groups. So these people
Speaker 2: who when they speak, they're seem to be less credible
Speaker 2: when they speak, so they're less likely to be seen
Speaker 2: as trustworthy and less likely to be believed.
Speaker 3: And these, as I said, are.
Speaker 2: People who from minoritized groups, people of color, women, people
Speaker 2: who are very old or very young, people who are
Speaker 2: LGBTQ plus, so they're just less trusted and therefore less
Speaker 2: listened to. And I realize it's not just patients you
Speaker 2: go unheard in healthcare. It's also minoritized doctors, minoritized researchers,
Speaker 2: and this can happen at a global level as well.
Speaker 2: And that kind of thing about when you think about
Speaker 2: the patient doctor kind of contact thing, people are dismissed,
Speaker 2: they're not believed. They can feel like they're being gas lit.
Speaker 2: So you know, that's really that phrase, it's all in
Speaker 2: your head. They might feel like that, and they just
Speaker 2: may feel like they've been ignored. So they've gone, you know,
Speaker 2: at their most vulnerable with their concerns to their doctor,
Speaker 2: and the doctors kind of said okay, but then they
Speaker 2: haven't acted on their concerns, so perhaps you know, they
Speaker 2: haven't reassured them or refer them or done a test.
Speaker 2: So I think there are different ways in which people
Speaker 2: can feel unheard, but I think that feeling of being
Speaker 2: gas lit is a really common one.
Speaker 1: You also introduce the term epistemic injustice as a framework
Speaker 1: to understand the ways people feel unheard in medicine. Can
Speaker 1: you take us through this term in the different types
Speaker 1: of epistemic injustice.
Speaker 2: This was a term which comes from philosophy, So the
Speaker 2: British philosopher Miranda Frica coined it in two thousand and seven,
Speaker 2: and she basically define this as being a wrong occurring
Speaker 2: to someone in their capacity as a noah. So basically,
Speaker 2: as humans, we like to create knowledge and we like
Speaker 2: to be able to pass it on. It's part of
Speaker 2: what makes us human. And when we can't do this,
Speaker 2: we experience an injustice. And you know, this is one
Speaker 2: injustice amongst many other injustices that people who are minoritized
Speaker 2: might face. And there are a couple of types of
Speaker 2: epistemic injustice. There's one called hermeneutical injustice and one called
Speaker 2: testimonial injustice, and I talk about both, but I think
Speaker 2: I want to concentrate more on testimonial injustice here because
Speaker 2: I think it's something that people will identify with. With
Speaker 2: testimonial injustice, it's basically, when someone speaks, the listener is
Speaker 2: less likely to believe what they say or listen to
Speaker 2: them because they don't feel they're credible due to aspects
Speaker 2: of their social identity. So for example, if you are
Speaker 2: a woman of color, you may not be seen as
Speaker 2: being credible, so you're less likely to be listened to.
Speaker 2: So it's often minoritized people who experience this testimonial injustice,
Speaker 2: and they experience what's called a credibility deficit, so they're
Speaker 2: not seen as being credible speakers by the listener. And
Speaker 2: actually it can happen in the other way as well,
Speaker 2: so you can experience an injustice if you are taken
Speaker 2: too seriously, so you can have a credibility excess. So
Speaker 2: you know, quite commonly it's white men who speak on something.
Speaker 2: Actually they don't know that much about. I don't know
Speaker 2: if you've seen this anywhere.
Speaker 1: Noe, never, I've never experienced that.
Speaker 2: So they say something and people are like, yes, probably right,
Speaker 2: so I'll believe them. So they actually also experienced an injustice,
Speaker 2: but perhaps one that doesn't cause them harm so much.
Speaker 1: When a medical provider does not listen to or ignores
Speaker 1: their patient's concerns, that can impact both whether that person
Speaker 1: receives care at all, as well as the quality of
Speaker 1: care received. What are some of the immediate and long
Speaker 1: term health impacts of being unheard.
Speaker 2: So I think the most kind of immediate thing is
Speaker 2: that you just you don't get treated or diagnosed. So
Speaker 2: you're telling you know, your doctor your symptoms and then
Speaker 2: nothing is done, so you may not be referred for tests,
Speaker 2: so you may have like a delayed diagnosis, or you
Speaker 2: may have the wrong diagnosis misdiagnosis, or you may get
Speaker 2: the wrong treatment or no treatment at all. And I
Speaker 2: think in its extreme sense, it can be very dangerous.
Speaker 2: It can be very harmful. I think we see all
Speaker 2: the time in kind of patient safety reports. So for example,
Speaker 2: there's been a lot about maternal mortality, both here in
Speaker 2: the UK and in the US, and a lot of
Speaker 2: the reports say that women and their relatives say that
Speaker 2: they are not listened to or believed when they are
Speaker 2: experiencing care. So kind of at its worst, it can
Speaker 2: even cause death. In terms of kind of the more
Speaker 2: other long term things, I think if you are routinely
Speaker 2: not listened to by your health care provider, routinely not heard,
Speaker 2: it means that you're kind of less likely to go
Speaker 2: back to them, so you don't trust them.
Speaker 3: It increases mistrust.
Speaker 2: And you might think, you know, I actually don't want
Speaker 2: to tell them what's going on. So you may avoid
Speaker 2: healthcare or you may self censor. So if your doctor says,
Speaker 2: you know, what's happening with your treatment, how's it going
Speaker 2: for you, and you've told them time and time again
Speaker 2: that you're getting side effects, you might just give up
Speaker 2: and say, oh no, they're fine. But in your own time,
Speaker 2: just stop taking the tablets for example. So I think
Speaker 2: you can have, you know, a real effect of silencing
Speaker 2: mistrust and kind of health care avoidance.
Speaker 1: Let's take a quick break here, and when we get back,
Speaker 1: there's still so much to discuss. Welcome back everyone. I've
Speaker 1: been chatting with doctor Ragashri Derewan about her book Unheard,
Speaker 1: the Medical Practice of Silencing. Let's get back into things.
Speaker 1: The dismissal of patients by healthcare providers is not something
Speaker 1: that happens spontaneously, as you point out, it is an
Speaker 1: explicit and implicit part of training where the foundations are
Speaker 1: laid out for their hierarchical relationship between physician and patient.
Speaker 1: Can you talk about what that training is like and
Speaker 1: why it's viewed as an essential part of patient care.
Speaker 2: Yeah, so I talk quite a bit about medical school
Speaker 2: in one of the chapters because I think that's really
Speaker 2: where we start to develop this almost skepticism of the
Speaker 2: patients already coming from a thought that we don't believes
Speaker 2: right from the beginning. So one of the ways in
Speaker 2: which we talked about medicine, particularly in the West, is
Speaker 2: the bimedical approach. So this is where we think of
Speaker 2: the disease being separate to the patient, so it's not
Speaker 2: part of them as a whole. It's a separate thing.
Speaker 2: And our job as doctors is essentially to find the
Speaker 2: diagnosis and then treat the patient, So we don't really
Speaker 2: think of a patient as a whole, and it means
Speaker 2: that we don't necessarily provide holistic care.
Speaker 3: So it really teaches.
Speaker 2: Us to keep a distance from the patient, and it
Speaker 2: means that we're more likely to have boundaries. And I'm
Speaker 2: not saying boundaries are bad. Boundaries are a good thing
Speaker 2: as well, but sometimes when we have very rigid boundaries,
Speaker 2: we don't listen as well as we can do. And
Speaker 2: it means that we as a doctor, we hold the
Speaker 2: knowledge and the expertise, and it means that we can
Speaker 2: be very paternalistic because we think we know best, we
Speaker 2: know better than the patient themselves about their own bodies.
Speaker 2: And I think the other things about medical school is, certainly,
Speaker 2: you know, as medical students, you've come through so much
Speaker 2: to get to where you are.
Speaker 3: You know, you've passed.
Speaker 2: Exams, you are you know, some of the cleverest people
Speaker 2: at university, and you're taught together because you have long hours,
Speaker 2: so you kind of end up really being tight as
Speaker 2: a group. And I think that separation and that feeling
Speaker 2: of being special and separate to other students means that
Speaker 2: we can develop a sense of hubris or excessive pride,
Speaker 2: and again that can make us seem kind of more
Speaker 2: unapproachable and less empathic. And I think the other thing
Speaker 2: about the biomedical approach that I was saying is if
Speaker 2: our job as doctors is to diagnose and fix, that's
Speaker 2: what we think our role is, but we don't think
Speaker 2: about other ways in which we could treat patients. So,
Speaker 2: for example, there is value in more holistic care, and
Speaker 2: sometimes I don't think we think about that, So we
Speaker 2: are less likely to listen, for example, when someone is
Speaker 2: telling us something that we don't know how to fix.
Speaker 2: So if someone, for example, has an issue with chronic
Speaker 2: pain and we don't know what to do about it,
Speaker 2: then we find that uncomfortable because we can't fix them,
Speaker 2: and that makes us really question our role as doctors,
Speaker 2: so we might be more likely to shut them down
Speaker 2: and not listen to them. But I think if we
Speaker 2: were taught to find more value in listening as being
Speaker 2: therapeutic in itself, so being witnessed to somebody who is suffering,
Speaker 2: then I think we would see our role as being
Speaker 2: more healers rather than fixers, and we would be better
Speaker 2: at listening in that way. And there's a couple of
Speaker 2: other things at medical school which I think contribute to
Speaker 2: this not listening as well.
Speaker 3: We learn very early on to.
Speaker 2: Be very focused with our history taking, and you know,
Speaker 2: that is a good thing because you know, we need
Speaker 2: to find out what's going on with the patient, but
Speaker 2: sometimes it means we kind of strip away everything else
Speaker 2: that we don't think is important, and again that makes
Speaker 2: us not as good listeners. I have this concept in
Speaker 2: the book of something called the ideal patient. So you know,
Speaker 2: someone has a heart attack, they present in a specific way,
Speaker 2: we kind of know what we expect them to say,
Speaker 2: but if they present in an atypical way or they
Speaker 2: respond in a way that we don't necessarily expect them
Speaker 2: to that we haven't been taught to that we're more
Speaker 2: likely to be skeptical of them and doubt them and
Speaker 2: not listen to them. So I think there's lots of
Speaker 2: things in medical school in the way that we're taught
Speaker 2: which really makes it less easy for us to learn
Speaker 2: to listen better.
Speaker 1: Also, in your book, you present these quotes from the
Speaker 1: thirteenth and seventeenth century discussing how or instructing physicians to
Speaker 1: doubt their patients and question their intentions. So it goes
Speaker 1: back literally like we're fighting hundreds of years of this.
Speaker 1: How is this tendency to doubt still reflected in the
Speaker 1: language used in medicine and enabled by the power dynamic
Speaker 1: of physician patient relationships.
Speaker 2: So I was really shocked when I found how long
Speaker 2: it has been going on for actually, like I didn't
Speaker 2: realize it had gone on for so long. So yeah,
Speaker 2: I think it is ingrained in our profess and ingrained
Speaker 2: in our language. So for example, I think, you know,
Speaker 2: we use language which kind of puts a patient at
Speaker 2: a distance and has kind of innate skepticism in it. So,
Speaker 2: for example, some of the medical language, we may use
Speaker 2: terms like the patient denied or the patient claimed, so
Speaker 2: that's kind of inherently skeptic of the patient, or it
Speaker 2: might be derogatory language. So there's a term that we
Speaker 2: use here in the UK. I'm not sure if you
Speaker 2: guys use it in the US, but what we call
Speaker 2: a heart sink patient, so someone when we see them,
Speaker 2: we know, oh, gosh, this is going to be a
Speaker 2: difficult consultation, and we can sometimes use language that is
Speaker 2: victim blaming and language that is paternalistic. So I work
Speaker 2: in HIV medicine where we really want patients to take
Speaker 2: their tablets every day. It's very important, but we talk
Speaker 2: about patient compliance and you know that sounds like a
Speaker 2: very paternalistic attitude to patients. It's not a very patient
Speaker 2: focused language. So I think it really is inherent in it.
Speaker 2: And the other thing is there is a lot of
Speaker 2: use to humanizing language. So again from my specialty of HIV,
Speaker 2: you know, you can see people saying things like the
Speaker 2: HIV patient, but there's been a real shift to talking
Speaker 2: about people living with HIV, so being person focused first.
Speaker 1: If the problem of silencing patients begins during medical training,
Speaker 1: and also like hundreds of years in the making, it
Speaker 1: is only exacerbated by the way modern medicine is practiced,
Speaker 1: where the emphasis tends to be on maximizing productivity. In
Speaker 1: what ways does the medical system hinder or even discourage
Speaker 1: physicians from adequately listening to their patients.
Speaker 2: So I think you're really right when you talk about
Speaker 2: that emphasis on productivity. So it's you know, numbers of patiency,
Speaker 2: number of tests done, number of diagnoses, number of treatments.
Speaker 3: You know, we get paid on that.
Speaker 2: And really what isn't valued are those consultations where listening
Speaker 2: in itself is therapeutic. So you know, we're not going
Speaker 2: to get paid for just you know, listening to a
Speaker 2: patient who is having a hard time and at the
Speaker 2: end of the consultation leaves feeling better because they feel
Speaker 2: like someone has hurt them. So that just isn't valued
Speaker 2: by our medical systems. You don't get money for that.
Speaker 2: And because there is an emphasis on productivity, it means
Speaker 2: that we are often short of time, so we often
Speaker 2: too busy to listen. Well, we're looking at our watches,
Speaker 2: were needing to go on to the next patient. We
Speaker 2: work in environments that aren't very good for listening, so
Speaker 2: for example, we work with very clinical rooms, so it
Speaker 2: may not feel like a welcoming or comforting space, or
Speaker 2: they may not be privacy where people feel that they
Speaker 2: can talk. And I think with the emphasis on being
Speaker 2: more productive, and I think, particularly since the pandemic, I
Speaker 2: think healthcare workers are increasingly tired, stressed, burnt out, and
Speaker 2: those are all conditions which mean that we listen not
Speaker 2: as well as we could do.
Speaker 1: And I really loved, like I said, how you provided
Speaker 1: this perspective from the physicians as well. And so in
Speaker 1: these scenarios in your book, you describe someone who is
Speaker 1: seeking medical care, and then you kind of give the
Speaker 1: perspectives from both different healthcare providers associated with the patient
Speaker 1: and the patient themselves. What might be going through their head,
Speaker 1: what might they be feeling? And I think that these
Speaker 1: scenarios help to illustrate the nuance in these interactions where
Speaker 1: sometimes there might be doubt, sometimes disbelief, sometimes neglect, and
Speaker 1: sometimes simple just miscommunication or just like forgetfulness, but all
Speaker 1: of these things tend to end up with more or
Speaker 1: less the same result in terms of harm or in
Speaker 1: terms of lack of care. Do you feel that the
Speaker 1: distinction between an unwillingness to listen and not having the
Speaker 1: capacity to listen due to things like you mentioned compassion fatigue.
Speaker 1: Do you think making that distinction is important, like is
Speaker 1: one more easily addressed than the other.
Speaker 2: I think that's a really good question, and you're right,
Speaker 2: they lead to the same thing. I think that most
Speaker 2: healthcare providers, most doctors do want to listen. I think
Speaker 2: we kind of go into the field because we're you know,
Speaker 2: people who are we're caring people. We want to make
Speaker 2: people feel better. So I think generally for most people
Speaker 2: there is a willingness to listen, and often it is
Speaker 2: our training or the environments that we're working in, which
Speaker 2: means that.
Speaker 3: It's harder for us to do so.
Speaker 2: But I do think there is an unwillingness to listen sometimes,
Speaker 2: so as I've said, you know, when we're uncomfortable hearing
Speaker 2: what the patient is saying because we don't know what
Speaker 2: to do, or when things are uncertain so again we're
Speaker 2: not entirely sure what is the next step to take.
Speaker 2: I think that's when we shut patients down. So I
Speaker 2: think there is that unwillingness to listen. But again I
Speaker 2: think that comes from how we're trained to be someone
Speaker 2: who is a fixer rather than someone who is a
Speaker 2: healer and can just listen. So I think whether it's
Speaker 2: unwillingness or not having the capacity to listen, I think
Speaker 2: both involve system change, and they're both really important.
Speaker 1: Let's take another quick break. We'll be back before you
Speaker 1: know it. Welcome back, everyone. I'm here chatting with doctor
Speaker 1: Ragashri Darawan about her book Unheard. Let's jump back into
Speaker 1: some questions, getting into some of those changes that we
Speaker 1: could make. I loved how in your book you had
Speaker 1: at the end of chapters here are ways that we
Speaker 1: can change things at different levels of organization, at an
Speaker 1: individual level, training and so on, And I was wondering
Speaker 1: if you could speak to that a little bit more.
Speaker 1: When it comes to medical training, how can we fix
Speaker 1: this from the ground up, or how can individual providers
Speaker 1: sort of reassess their own listening skills or maybe where
Speaker 1: they could improve.
Speaker 2: So I think there's things for individuals to do, and
Speaker 2: I think there's things for system change, which starts from
Speaker 2: medical training and education all the way to kind of
Speaker 2: how institutions are run and kind of post qualification training.
Speaker 2: So I think as individuals, I think it's really important
Speaker 2: that we learn to reflect on our listening and certainly
Speaker 2: since writing the book, that's something I've been doing a
Speaker 2: lot more of a thinking, you know, why was that
Speaker 2: consultation difficult? Like what happened in it that might have
Speaker 2: made it difficult for me to really listen to what
Speaker 2: the person was saying. Being aware obviously that you know,
Speaker 2: we all hold bias, and thinking about when that's most
Speaker 2: likely to come up, so you know, we're more likely
Speaker 2: to rely on stereotypes and what I call heuristics, so
Speaker 2: mental shortcuts when we're tired or stressed. So you know,
Speaker 2: for example, you may not be so good at listening,
Speaker 2: or you may be more biased when it's three o'clock
Speaker 2: in the morning, you're in the emergency department and it's
Speaker 2: really busy. So I think individual reflection is important, but
Speaker 2: I think listening should be taught at university, right from
Speaker 2: medical school, so how we can be better listeners, And
Speaker 2: also really taking that emphasis away from thinking all patients
Speaker 2: present in a certain way. Patients may not present in
Speaker 2: a way that we necessarily expect them to, and not
Speaker 2: using that as kind of excuse not to believe them
Speaker 2: or to feel that we're skeptical of them. Understanding that
Speaker 2: people present diversity, people are diverse. I think there's also
Speaker 2: something there around being taught about the value of listening
Speaker 2: and that listening in itself can be therapeutic, so really
Speaker 2: taking us away from that kind of fixer model of
Speaker 2: being doctors to being healers again. And I think also
Speaker 2: really important in medical school is learning more about the
Speaker 2: social determinants of health, so understanding why people don't present
Speaker 2: as we expect them to, why they don't behave as
Speaker 2: we expect them to. And understanding more about the history
Speaker 2: of medicine, so you know, understanding about bias, the history
Speaker 2: of medical experimentation, etc. And then when we get into
Speaker 2: kind of clinic practice, I think there needs to be
Speaker 2: a room for more reflection in the workforce generally. So
Speaker 2: I've talked about how you know there should be planned
Speaker 2: reflection time, so having team supervision, so in clinical practice
Speaker 2: often if something bad happens, then the team might reflect.
Speaker 2: But building that into kind of everyday practice so teams
Speaker 2: together can talk about their experiences about what went well
Speaker 2: and what didn't I think would be really good for
Speaker 2: everyone and would help prevent some of that compassion fatigue
Speaker 2: and burnout. And I guess the other things are about
Speaker 2: making better listening environments, so you know, making those private
Speaker 2: spaces more available, making sure that we have regular breaks
Speaker 2: so that we can then feel rejuvenated again, more likely
Speaker 2: to listen, and thinking what does productivity mean? Maybe it
Speaker 2: does mean just listening as being a therapeutic tool.
Speaker 1: Getting a bit more into what that reflection looks like.
Speaker 1: You discuss in your book how well you as a
Speaker 1: physician sometimes don't always listen as well as you could.
Speaker 1: Can you talk about what those moments are like? Is
Speaker 1: it something that you realize at the time where you're
Speaker 1: not being a good listener or did it just like
Speaker 1: feel like you said, like this was this consultation didn't
Speaker 1: feel great or didn't something was not right about it?
Speaker 1: Or was it in retrospect that you're seeing this or
Speaker 1: is it a combination of both.
Speaker 3: I think it's a combination of both.
Speaker 2: So sometimes you know, when you're you know, for example,
Speaker 2: in a busy clinic and you're rushing and you're trying
Speaker 2: you're on the computer trying to order tests while also
Speaker 2: listen to the patient, you're trying to make notes, or
Speaker 2: you know, someone pops in to tell you something, or
Speaker 2: an email pops up on your computer. You know that
Speaker 2: you are distracted and you know that you're perhaps not
Speaker 2: listening or focusing as well as you can be. And
Speaker 2: you know, obviously doctors a human you may have not
Speaker 2: had a good night's sleep before, you might be tired
Speaker 2: and know that you're not at your best, or you
Speaker 2: know something's happening in your personal life. So I think
Speaker 2: you can be aware of that at the time, but
Speaker 2: sometimes you're not so aware. So it may be kind
Speaker 2: of towards the end of the consultation when you're just like, oh,
Speaker 2: you know that didn't feel right as you said, or
Speaker 2: you know that was an uncomfortable consultation. I don't feel like,
Speaker 2: you know, the patient got what they wanted and I
Speaker 2: got what I wanted from the consultation. But I think
Speaker 2: sometimes you don't even realize, and I think that can
Speaker 2: happen to any doctor, but it is, you know, sometimes
Speaker 2: you think you've done your best, but the patient doesn't
Speaker 2: agree for you. So I think trying to recognize when
Speaker 2: you know you're not listening, trying to reflect on those
Speaker 2: consultations which are uncomfortable, but then also kind of learning
Speaker 2: from patient feedback as well, and I think feedback is
Speaker 2: really important from colleagues and patients throughout our career to
Speaker 2: make sure you know, we understand how well we are
Speaker 2: communicating and listening.
Speaker 1: Patients who are unheard by their providers are often or
Speaker 1: sometimes told that they should better advocate for themselves, which,
Speaker 1: as you point out, is a form of victim blaming
Speaker 1: because it shifts the responsibility for the signalancing of patients
Speaker 1: to the patients themselves, and it enables the medical community
Speaker 1: to just keep things as they are or it doesn't
Speaker 1: really drive any sort of change. But until the medical
Speaker 1: institution takes meaningful steps to ensure better listening, what are
Speaker 1: some of the ways that people can increase the chances
Speaker 1: that they will be heard or listened to by their
Speaker 1: healthcare providers.
Speaker 2: Yes, this is exactly why I wrote the book because
Speaker 2: I wanted the healthcare system to change. But absolutely, I
Speaker 2: mean it's not going to change quickly, and I think
Speaker 2: it's really important that everyone has the agency to try
Speaker 2: and get what they need from the healthcare service. So
Speaker 2: I do provide some tips. So if you are going
Speaker 2: in for a consultation with a doctor, I think it's
Speaker 2: really important to be prepared. If you're prepared, perhaps if
Speaker 2: you know a little bit about your condition, or you
Speaker 2: know what questions you want to ask. So, for example,
Speaker 2: I always love it when my patients write a list,
Speaker 2: so they come in with their list already thought about
Speaker 2: and then we sit and go through each point like
Speaker 2: I think, that's great. You know, so you feel like
Speaker 2: you've asked everything that you want to. But importantly, it
Speaker 2: makes a doctor feel that you care about what's going on.
Speaker 2: It makes you seem more credible. So I definitely recommend
Speaker 2: planning for your consultation. You can always write things down
Speaker 2: while you're there as well, and I think if you're
Speaker 2: writing things down that you don't understand, then ask the
Speaker 2: doctor what it means. I think sometimes with this innate
Speaker 2: power imbalance between doctors and patients, it can feel scary
Speaker 2: to ask things. So I always say, if you want to,
Speaker 2: you should take someone with you, like a friend or
Speaker 2: a relative who can advocate for you. And if you do, again,
Speaker 2: prepare them so they know what you want answers to.
Speaker 2: So if you don't get a chance to ask the
Speaker 2: questions yourself, then they can ask it for you and
Speaker 2: they can stick up for you as well. I think
Speaker 2: if you can, if you would find it helpful to
Speaker 2: see the same doctor then ask. I think seeing someone
Speaker 2: who knows you and you know you've already had a
Speaker 2: good consultation with would be really helpful. So continuity of care,
Speaker 2: I think it's important, and you can ask for it
Speaker 2: often and if it doesn't go well, I think it's
Speaker 2: really important to know your rights, so kind of know
Speaker 2: who's in charge of your care, where you can complain to,
Speaker 2: and that you can get a second opinion, and that
Speaker 2: you can ask for it.
Speaker 3: I think that's really important.
Speaker 2: And also I think another thing about being prepared is
Speaker 2: just letting before your appointment, letting them know if you
Speaker 2: have any special communication needs, so if you need an
Speaker 2: interpreter or something like that, then that's really helpful to
Speaker 2: the doctor as well.
Speaker 3: Other things.
Speaker 2: Please bring any medications you're on. It's really helpful to
Speaker 2: know exactly what you're taking. If you're seeing other doctors
Speaker 2: and you have results and things, bring all of that
Speaker 2: with you. It's really nice for us to see it.
Speaker 2: And I do write in the book, but sadly, I
Speaker 2: think lots of studies show that doctors find patients more
Speaker 2: credible if they are you know, if they can be
Speaker 2: if they can appear more well dressed, And I think
Speaker 2: that's a terrible thing, but it does improve credibility. And
Speaker 2: you know, I talk in the book about my mother,
Speaker 2: who is a who's a retired family doctor, but she's
Speaker 2: also you know, an older Indian woman, and stereotypes about
Speaker 2: them is that you know that they often complain about
Speaker 2: things that are all in their head, and she actually
Speaker 2: gets dressed up to go to her doctor appointments, and
Speaker 2: you know, I don't think that should happen at all,
Speaker 2: but there are lots of studies to show that people
Speaker 2: do it and it can help them come across as
Speaker 2: more credible. So I'm not really saying that as a tip,
Speaker 2: but I think people should be aware of it. And
Speaker 2: obviously there's times when you can't be, so you know,
Speaker 2: if it's an emergency, you know that's not going to happen.
Speaker 2: So I kind of give all these tips of the
Speaker 2: huge caveat, but it is not down to the patients
Speaker 2: who have to kind of speak up to be heard.
Speaker 2: We should be listening more, but in an imperfect healthcare system,
Speaker 2: these are things that you can do.
Speaker 1: And of course, as you discuss, it's not just patients
Speaker 1: that face issues with being unheard. Can you talk about
Speaker 1: testimony injustice, in credibility deficit, and how this affects minoritized
Speaker 1: doctors as well.
Speaker 2: Yeah, so we've talked about testimonial injustice with regards to patients,
Speaker 2: but yeah, minoritized doctors and researchers go unheard. So there
Speaker 2: is a good example of how it can happen. I
Speaker 2: write it in the book. So imagine you're in like
Speaker 2: a work meeting and you're having a discussion in a
Speaker 2: group and you say something, and you know, you think
Speaker 2: you've made this amazing point and you say it and
Speaker 2: you're kind of waiting for everyone to go, yeah, that's
Speaker 2: a great point, but no one says anything, and the
Speaker 2: discussion kind of moves on, and then like a few
Speaker 2: minutes later, someone else makes exactly the same point as you,
Speaker 2: and they get praised for it. And you know, that's
Speaker 2: definitely happened to me in meetings may have happened to
Speaker 2: you as well. So what you have experienced there is
Speaker 2: testimonial injustice, and I think that can happen to anybody.
Speaker 2: But I think if it happens repeatedly to people, then
Speaker 2: you're just more likely to not speak up because you
Speaker 2: think no one's really listening to me. So why bother
Speaker 2: and what this can do in terms of career prospects
Speaker 2: for minoritized doctors mean that they lose their self confidence.
Speaker 2: You know, they feel less likely to speak up because
Speaker 2: they won't be heard. That means they won't apply for
Speaker 2: you know, promotions or posts on boards, and this can
Speaker 2: have a real impact in terms of their career progression.
Speaker 2: And it can make them feel kind of excluded from
Speaker 2: the workforce. And I think it's really important that minoritized
Speaker 2: doctors get listened to one to have a diverse workforce,
Speaker 2: but it's good for patients as well. So yeah, I
Speaker 2: have a whole chapter about how minoritized doctors go unheard
Speaker 2: and the effect it can have on patients.
Speaker 1: I know that you have a whole chapter on it,
Speaker 1: but can you dive into that a little bit and
Speaker 1: give us some examples of how a more diverse medical
Speaker 1: workforce can improve patient health.
Speaker 2: So there's actually quite a lot of research to show this,
Speaker 2: And if you're listening, you know, it may be something
Speaker 2: that you've experienced yourself. So you know, it may be
Speaker 2: easier to talk to a doctor perhaps who looks like
Speaker 2: you or comes from a similar social background to you.
Speaker 2: You may feel kind of more comfortable with them. But
Speaker 2: in terms of research, there's lots to show that a
Speaker 2: more diverse workforce is better for diverse patients.
Speaker 3: So there is a study that I quote, for.
Speaker 2: Example, which is from the US in twenty twenty three,
Speaker 2: which showed that in counties with more black primary care doctors,
Speaker 2: black people had longer life expectancy and lower mortality rates.
Speaker 2: And that is absolutely huge. Isn't it to show that
Speaker 2: having more black doctors means that black patients do better.
Speaker 2: So there's lots of different research studies which show this,
Speaker 2: so it can have a real impact on patient care.
Speaker 2: And if you think, you know minoritize doctors who aren't heard,
Speaker 2: they're not able to stick up for their patients, so
Speaker 2: their patients then suffer. So it's really important that we
Speaker 2: keep the workforce diverse and also acknowledge that some patients
Speaker 2: also may not want doctors that look like them. And
Speaker 2: I think about this in sexual health a lot, where
Speaker 2: perhaps you know, some of our patients don't want to
Speaker 2: see someone who looks like they're from their community because
Speaker 2: they're worried about confidentiality. So if you've got a diverse workforce,
Speaker 2: you can give patient choice as well, and I think,
Speaker 2: you know, patients have the experience of seeing lots of
Speaker 2: different doctors, some of who may suit them, some who
Speaker 2: may not.
Speaker 1: As you kind of alluded to, research or knowledge gaps,
Speaker 1: especially when it comes to conditions that predominantly affect minoritized groups,
Speaker 1: take a long time to fill in. What are some
Speaker 1: of the factors contributing to these research gaps, from funding
Speaker 1: to structural barriers, and how do these gaps impact care.
Speaker 2: A really good example of this is endometriosis, in that
Speaker 2: this is a condition which until quite recently, we didn't
Speaker 2: know that much about, despite affecting one in ten cisgender
Speaker 2: women around around the world. So this is, you know,
Speaker 2: women have complained of symptoms of endometriosis for centuries, but
Speaker 2: because doctors have been male, their symptoms have not been
Speaker 2: taken seriously, and because of that, the research hasn't been done,
Speaker 2: leaving us with this big research gap, which means that
Speaker 2: we still don't know what causes endometriosis, what are the
Speaker 2: best ways to treat it, how we can help someone
Speaker 2: get pregnant if they have endometriosis, even though there's been
Speaker 2: a lot of push to change this in recent years,
Speaker 2: and I think that's probably because we have more more
Speaker 2: female doctors and researchers. When we look at funding levels,
Speaker 2: we still see that funding, for example, for menstrual conditions
Speaker 2: is much lower compared to conditions that affect mostly men.
Speaker 2: So we still see these real kind of disparities in
Speaker 2: funding for patient groups who are less heard. I talked
Speaker 2: about kind of you know, testimonial injustice with regards to
Speaker 2: minoritized doctors, but we see it in research as well.
Speaker 2: So minoritize researchers are more likely to study conditions that
Speaker 2: affect minoritized patients. And when they're not heard, you know,
Speaker 2: they may not get jobs, they may not get promotions, grants,
Speaker 2: they may not get their research published or cited. All
Speaker 2: those things affect their career progression and mean that their
Speaker 2: research is less likely to be done, which means that
Speaker 2: the conditions that affect minoritize patient groups are less likely
Speaker 2: to be researched and studied. So you know, we have
Speaker 2: that gap. And if you think of that on a
Speaker 2: really wider scale, if we think kind of when we
Speaker 2: look at global health, we know that global north researchers
Speaker 2: are much more likely to be seen as credible researchers
Speaker 2: and they get all the grants and all the funding,
Speaker 2: leaving Global South researchers going unheard as well as the
Speaker 2: communities that they serve when it comes to research.
Speaker 1: Yeah, I'm so glad that you brought up global health
Speaker 1: because I wanted to ask about sort of the imperialist
Speaker 1: and colonialist roots of global health and how those have
Speaker 1: left traces in the way that this field is practiced today,
Speaker 1: or the topics and approaches that are prioritized in research.
Speaker 1: So I was wondering if you could just talk a
Speaker 1: little bit more about that.
Speaker 3: So I think I think.
Speaker 2: There's been lots of discussion in global health recently about
Speaker 2: how its origins kind of come from disease control during
Speaker 2: colonial times and the approaches then still exist to this day.
Speaker 3: So there is this.
Speaker 2: Kind of feeling of, you know, knowledge that comes from
Speaker 2: the global North, so the countries that colonized other countries
Speaker 2: is superior. So you know, when it came to colonization,
Speaker 2: it wasn't just about taking land. It was also about
Speaker 2: erasing local knowledge and culture, and that included medicine. So
Speaker 2: Western medicine was part of colonialism. So replacing local health
Speaker 2: knowledge with Western medicine, and I think global health has
Speaker 2: continued to do this. So I think there is a
Speaker 2: critique at the moment saying that we do need to
Speaker 2: decolonize global health. We need to value the local knowledge
Speaker 2: of researchers in the global South and understand that they
Speaker 2: are just as credit as researchers in the global North,
Speaker 2: and if not more credible when it comes to conditions
Speaker 2: that affect their communities. So there needs to be more
Speaker 2: power sharing. So power needs to go from researchers in
Speaker 2: the global North to the South. And one of the
Speaker 2: critiques of kind of the history of global health has
Speaker 2: been around how organizations in the global North have kind
Speaker 2: of enacted policies on communities in the global South that
Speaker 2: have been colonized without really collaborating with them and without
Speaker 2: understanding that perhaps they're order is knowledge of how to
Speaker 2: treat some diseases, but you know that has been devalued
Speaker 2: and sometimes erased.
Speaker 1: I pulled a quote from in my notes from your
Speaker 1: book where you state that global health continues to see
Speaker 1: local people as being part of the problem, not the solution,
Speaker 1: And I feel like that was like, yes, that is
Speaker 1: exactly what is always happening, and really is I think
Speaker 1: a challenge, like just like with medical training, just like
Speaker 1: anything where the change has to start from the beginning.
Speaker 1: It's like going to just take so much time and
Speaker 1: effort to correct and to fix things and to progress
Speaker 1: and in a better way than we are currently doing.
Speaker 2: Yeah, And I think throughout the book, I think one
Speaker 2: of the main themes is it's about power and people
Speaker 2: who hold the power, be that doctors, be that researchers
Speaker 2: in the global North are going to have to give
Speaker 2: up some of that power, and that, I think is
Speaker 2: I think that's going to be the issue, but they
Speaker 2: need to we need to understand that it means that
Speaker 2: it's better for everyone overall if power sharing occurs.
Speaker 1: Going back to the physician patient relationship, I want to
Speaker 1: talk a bit about the problem of objectivity and the
Speaker 1: divide between symptoms and signs. How is evidence ranked in medicine,
Speaker 1: and where does patient voice or experience fit in among
Speaker 1: those ranks.
Speaker 2: So I think we're talking about the hierarchy of evidence
Speaker 2: quite early on in our medical careers because we've kind
Speaker 2: of taught how to read research papers and to understand
Speaker 2: them and critique them. So at the top of the
Speaker 2: hierarchy are things like meta analyzes, systematic reviews, and then
Speaker 2: we see randomized control trials, and then things like case
Speaker 2: control studies, cohort studies, and then lower down are things
Speaker 2: like case series and expert opinion and animal studies. And
Speaker 2: essentially what the hierarchy is doing is the ones at
Speaker 2: the top are those that are study designs which have
Speaker 2: less biased and are seen to be more objective. And essentially,
Speaker 2: when it comes to research evidence, we value quantitative evidence
Speaker 2: much more highly. So you know, we value numbers and
Speaker 2: statistics because we think they are more objective. So obviously
Speaker 2: that kind of research has been really important and has
Speaker 2: improved patient care, so I'm not arguing against it. Evidence
Speaker 2: based care is a really really important thing which has
Speaker 2: improved patient care massively. But sometimes research questions aren't best
Speaker 2: answered by quantitative study designs. So you know, they're very
Speaker 2: good for asking how many or how much or is
Speaker 2: there a relationship between two things, But sometimes we need
Speaker 2: to understand how or why something happens, So other forms
Speaker 2: of evidence, like for example, qualitative evidence, may be useful,
Speaker 2: but it's really not as valued as highly as quantitative evidence.
Speaker 2: And I think what's really interesting about the hierarchy of
Speaker 2: medicine is that there is no patient voice in any
Speaker 2: of that. It's all thinking really about numbers and qualitative
Speaker 2: evidence isn't valued, and that does include some patient voice.
Speaker 2: So I think it's really striking to me how we
Speaker 2: value evidence which doesn't come from patients because we see
Speaker 2: it as being too subjective. So I think that has
Speaker 2: again an impact on how well we listen to patients.
Speaker 1: Maybe this is going a bit back to like the
Speaker 1: research gap discussion that we were, but I wanted to
Speaker 1: ask you about the table that you created for the
Speaker 1: most and least prestigious diseases. I found that really fascinating
Speaker 1: and truly eye opening. So could you just take me
Speaker 1: briefly through the characteristics of prestigious diseases and patients and
Speaker 1: not prestigious diseases and patients.
Speaker 2: Yeah, so this concept and this table came from research
Speaker 2: papers by Norwegian researchers. So yeah, I've just compiled it
Speaker 2: into a table to make it easier to read. But
Speaker 2: essentially it looks at how doctors look at diseases and
Speaker 2: value them and in turn value the patients who have
Speaker 2: those diseases. So things that might be more prestigious, for example,
Speaker 2: are conditions that have objective features, so you know, easy
Speaker 2: to see clinical signs or symptoms or test results. So
Speaker 2: for example, if you have HIV, you will have a
Speaker 2: positive HIV antibody test, so that is easy to test for.
Speaker 2: Other things that make disease seem more prestigious or valuable,
Speaker 2: for example, is if it's sudden or life threatening, if
Speaker 2: it affects patients who are young, for example, if the
Speaker 2: treatment is kind of active, a bit risky, but means
Speaker 2: that you can cure somebody. And also I think really
Speaker 2: interestingly the researchers say here in terms of patients, if
Speaker 2: the patient is more likely to listen to the doctor
Speaker 2: and accept what they say, those diseases in which the
Speaker 2: patient is more likely to do that are more prestigious.
Speaker 2: So when they ask Norwegian doctors over twenty five years
Speaker 2: to rank diseases by their prestige and kind of consistently
Speaker 2: over that time, they found the conditions like leukemia, heart attacks,
Speaker 2: and brain tumors to be the most prestigious diseases. So
Speaker 2: you can see those are ones of objective features that
Speaker 2: are life threatening and you need quite intensive treatment for it,
Speaker 2: whereas the diseases that are seen as less prestigious. Those
Speaker 2: are kind of the opposite. So there are fewer objective
Speaker 2: signs of symptoms, so you may have to rely, for example,
Speaker 2: more on patient testimony. There may be things in which
Speaker 2: there isn't an obvious cure or treatment, and there may
Speaker 2: be things in which the patient may have more to say,
Speaker 2: you know, they may be more likely to contest what
Speaker 2: the doctor says, and consistently over the twenty five years
Speaker 2: in this study. In this Norwegian study, fibromyalgia was found
Speaker 2: to be kind of the least prestigious disease, and I
Speaker 2: think we also see that with other conditions such as,
Speaker 2: for example, long COVID or MACFS. So these are again
Speaker 2: conditions which we can't just fix, which is not so
Speaker 2: easy to diagnose without patient testimony. So these are the
Speaker 2: conditions that doctors value less find less prestigious, and I
Speaker 2: think that really affects the patients you have them.
Speaker 1: I'm very curious to know sort of what reception or
Speaker 1: what sort of reactions that you have gotten from other physicians.
Speaker 1: Do you think that most people in the medical field
Speaker 1: are receptive to the idea that medical practitioners aren't always
Speaker 1: good listeners and that they don't always provide adequate care
Speaker 1: or has there been any defensiveness or I don't know,
Speaker 1: like just denial outright or is it mostly like yes,
Speaker 1: I understand and I can see that in myself.
Speaker 2: So I think actually people have been very receptive, which
Speaker 2: has been really encouraging, and it's really interesting. I mean,
Speaker 2: it does tend to be the people who have been
Speaker 2: patients themselves and have it been at kind of that
Speaker 2: end of being a patient and not being listened to,
Speaker 2: and I think, particularly for doctors, when that happens to
Speaker 2: you kind of makes you question everything. So people have
Speaker 2: been very receptive. And the other thing is, you know,
Speaker 2: all doctors at some point will probably be patients as
Speaker 2: they get older. So knowing that we will be on
Speaker 2: the other side ourselves at some point means that you know,
Speaker 2: we will be more receptive to it. And the other
Speaker 2: thing is there's so much evidence to show that patients
Speaker 2: say they go unheard. I don't think, you know, we
Speaker 2: can deny data at all. So people have been really receptive,
Speaker 2: and many of them have experienced it themselves as patients.
Speaker 2: But I think what is going to be interesting about
Speaker 2: the reaction to this book is the fact that I
Speaker 2: believe it is ingrained in our profession. I think many
Speaker 2: doctors will say, yes, we're not very good at listening
Speaker 2: because we work in environments that make it very hard
Speaker 2: to listen. But I think it'll be interesting to see
Speaker 2: what they think when I say, I think it's actually
Speaker 2: ingrained in our profession.
Speaker 3: Right from the beginning.
Speaker 1: You mentioned earlier in our discussion that working on this
Speaker 1: book has changed the way that you approach medicine. Can
Speaker 1: you describe a little bit about what you mean by that,
Speaker 1: How has your approach changed?
Speaker 2: So when I was writing kind of the book proposal
Speaker 2: and the first few chapters, I was very lucky because
Speaker 2: I had taken time away from clinical medicine. I took
Speaker 2: a year out after COVID off the second COVID wave,
Speaker 2: and did a master's full time. So I had a
Speaker 2: year out to study, which was wonderful, and I also
Speaker 2: had time to write the book proposal. So when I
Speaker 2: came back to clinical practice, I was still writing the book,
Speaker 2: and I thought, do you know what, I need to.
Speaker 3: Be better at listening? So I'm going to try really hard.
Speaker 2: And after a few months I realized it's really really hard.
Speaker 3: Listening is really hard.
Speaker 2: But I think what has really changed is that I'm
Speaker 2: so much more reflective than I used to be. I
Speaker 2: also now don't feel as uncomfortable as I used to, Like,
Speaker 2: I understand that if a patient wants to tell me
Speaker 2: about something which I can't actually help them with, it's
Speaker 2: okay for me just to listen because they come out
Speaker 2: of the consultation feeling better, so you know, it's not
Speaker 2: a futile consultation. I am still doing something therapeutic. So
Speaker 2: I think it's really made me reflect on every consultation
Speaker 2: and it's really made me value just the benefits of
Speaker 2: just listening and how that can help patients.
Speaker 1: Doctor Darawan, thank you so very much for taking the
Speaker 1: time to chat with me and for writing this incredible
Speaker 1: book that I'll say it again, I really think should
Speaker 1: be required reading for anyone going into medicine, and everyone
Speaker 1: already in medicine, and anyone who has an interest in medicine.
Speaker 1: Basically everyone should go read this book. So go check
Speaker 1: out our website, this podcast will kill You dot com.
Speaker 1: We're I'll post a link to where you can find
Speaker 1: Unheard the Medical Practice of Silencing, as well as a
Speaker 1: link to doctor Darrewan's author page. And don't forget. You
Speaker 1: can check out our website for all sorts of other
Speaker 1: cool things, including, but not limited to, transcripts, Quarantinian placeber
Speaker 1: reader recipes, show notes and references for all of our episodes,
Speaker 1: links to merch our bookshop dot Org, affiliate account, our
Speaker 1: Goodreads list, a first hand account form, and music by Bloodmobile.
Speaker 1: Speaking of which, thank you to Bloodmobile for providing the
Speaker 1: music for this episode and all.
Speaker 3: Of our episodes.
Speaker 1: Thank you to Leana Squalatchi and Tom Bryfocal for our
Speaker 1: audio mixing. And thanks to you listeners for listening. I
Speaker 1: hope you liked this episode and our loving being part
Speaker 1: of the TPWKY book Club. A special thank you, as
Speaker 1: always to our fantastic patrons. We appreciate your support so
Speaker 1: so very much. Well, until next time, keep washing those
Speaker 1: hands