Deborah Altow MD (biography and disclosures)
What I did before
Like many teachers, I was seduced by the imperative to make sure my students gained the benefit of my experience, and thus I talked too much. I had always told my students that the two 4-letter words they needed most were KIND and WAIT. One could never be too kind to a patient in distress, and one could learn how to fill in the gaps by WAITING for the patient to clarify, enlarge, or focus on, the issue. I was convinced that more talking meant better understanding, and that was clearly not the case!
What changed my teaching practice
A student offered a different version of WAIT: she explained it as “Why Am I Talking?” This question aimed straight at the need to stay quiet and listen for the clues that would be forthcoming if we didn’t fill the “dead air” of silence.
What I do now
As a former English teacher, I have found that sometimes trying different ways of saying something—or waiting for the student to suggest an idea according to what he/she is thinking—is productive. Thus the WAIT system seems to work well with another formula: the Institute for Healthcare Communication’s 4 “E”s–engage, empathize, educate and enlist.
By engaging the patient with a warm welcome and a smile, listening with empathy to the impact of the condition, educating the patient about options, risks, etc., and enlisting the collaboration of the patient, the WAITing pays off in better information, more trust, and likely more adherence to the treatment plan. Physicians can adjust the two teaching styles according to the situation and the patient.
Sometimes I offer students a quotation from Elizabeth Huxley’s “The Flame Trees of Thika”:
The best way to find out things is not to ask questions at all. If you fire off a question, it is like firing off a gun; “bang” it goes and everything takes flight and runs for shelter. But if you sit quite still and pretend not to be looking, all the little facts will come and peck around your feet, situations will venture forth and thickets and intentions will creep out and sun themselves on a stone; and if you are very patient, you will see and understand a great deal more than a man with a gun.
I hope this anecdote can be a timely reminder of the value of sitting quite still and waiting for those “situations and thickets” to emerge.