Sir William Osler’s best-known saying was “Listen to your patient, he is telling you the diagnosis,” which emphasises the importance of taking a good history. Well, that is how Wikipedia interprets the saying… but I think they got it wrong.
Certainly a good medical history is important; I was taught that by the end of that process the clinician should have at least a good provisional diagnosis. But the history is an interactive process led by the physician with very direct questions… what Osler is saying here is something quite different.
The variation of the quote that I heard was “If you listen to the patient long enough, they will tell you what’s wrong with them”. This is not the goal-oriented or diagnostic direction of the first quote, but one where the clinician is more receptive and allows the patient to simply tell their own story.
Of course, in the rigors of modern medicine and the 10 minute consult, this would seem to be an unnecessary luxury. However, when I was in practice I always allowed 30 minutes for the first consultation; not only did this allow me to listen to the patient’s story, it also allowed me to get to know them and make some sort of emotional connection – itself a vital component of the healing process.
Yet there are two deeper issues here. The first is that the narrative process will both reveal the problem and indicates that the patient knows it too, albeit subliminally or unconsciously. In this case the narrative process “brings it to light”.
The second issue is that if the patient actually “knows what’s wrong with them”, then they are tapping into their own healing powers or instinct. That being the case, they would also know how it is best managed.
I am aware this position has been arrived at intuitively, and also that it places a fundamental faith in the innate healing process in each and every one of us. But you’d better get used to it, as it is the truth!
You are your own best physician.