Listening Better Can Save Lives
It was 2008. I was working as an intern at a hospital in New Delhi, India. A young boy, perhaps 13 years old, came in for a blood transfusion. He had thalassemia so was no stranger to the hospital. I was preparing to start the IV line on the back of his left hand; I found a good vein and was about to put the needle in when he interrupted me. He stuck out his right middle finger and told me demurely to put it in the side of the finger. I gently told him – “No, that is not a good place, it is going to hurt there.” He was quiet and let me proceed. I tried the vein in the back of his hand, but I did not succeed; I tried again in his forearm and I again failed. I was feeling upset with myself at having poked a patient twice in vain. He again looked at me, stuck out his right middle finger and told me – “Doctor, try this, it will work.” Finally a light flickered in my head and I decided to listen to him. I tried to insert it in his finger – and lo and behold – it was a smooth insertion and the blood flowed into the cannula.
He did not say “I told you so,” but I felt sorry and stupid for not listening to him in the first place. Maybe if I would have stopped and asked him, “Why are you telling me to put it in the finger?” he would have had the chance to remind me that he had been getting transfusions all his life and knew his veins better than I did.
This was just two extra, albeit unnecessary, needle pricks; no one died, no major harm was done. But in another place, another time, a similar oversight of “not listening” led to a tragedy that would change the face of health care.
It was the year 2001, the place was one of the world’s finest hospitals, Johns Hopkins University Hospital in Baltimore, Maryland in the United States, where a two-year-old girl, Josie King, who was admitted with burns, died of dehydration because the nurses and doctors failed to listen to her. The little girl’s mother, Sorrel King, overcame her grief and anger at the loss of her daughter and has now become one of the foremost advocates for patient safety in the US.
Sorrel King, recounts the events of the tragedy and its aftermath in her book Josie’s Story.
Sorrel had noticed her daughter’s thirst two days prior to her demise and had repeatedly asked he nurse if she should be given a drink but the nurse had said no. Sorrel also recounts other instances during Josie’s hospital stay when doctors and nurses failed to respond adequately to the concerns she raised. Sorrel King says “[Josie] died because you did not listen to me.”
Every failure to listen, no matter how innocuous, should be considered a ‘near miss’ by each of us.
And we can only listen if we let go of our ego, if we become curious, if we become open to alternate possibilities and to the fact that ours is not the absolute truth. We have to realize that the perception, experience or information that another person has to share may alter our thinking and our course of action.
We talk of systems failure when we discuss patient safety and quality improvement, and it is true that a lot of safety issues may be outside of the domain of control of any single health care worker and may need new policies, procedures or require management support. But listening is one thing that each of us can do better, on our own or with the help of workshops and training programs that can teach us these skills. And if all of us are listening better to our patients and to our colleagues, it will be a powerful transformation towards a safer and gentler health care system.