What Patients Say, What Doctors Hear

by Danielle Ofri

Can refocusing conversations between doctors and their patients lead to better health?

Despite modern medicine’s infatuation with high-tech gadgetry, the single most powerful diagnostic tool is the doctor-patient conversation, which can uncover the lion’s share of illnesses. However, what patients say and what doctors hear are often two vastly different things.

Patients, anxious to convey their symptoms, feel an urgency to “make their case” to their doctors. Doctors, under pressure to be efficient, multitask while patients speak and often miss the key elements. Add in stereotypes, unconscious bias, conflicting agendas, and fear of lawsuits and the risk of misdiagnosis and medical errors multiplies dangerously.

Though the gulf between what patients say and what doctors hear is often wide, Dr. Danielle Ofri proves that it doesn’t have to be. Through the powerfully resonant human stories that Dr. Ofri’s writing is renowned for, she explores the high-stakes world of doctor-patient communication that we all must navigate. Reporting on the latest research studies and interviewing scholars, doctors, and patients, Dr. Ofri reveals how better communication can lead to better health for all of us.

Genres: Medicine, Nonfiction, Medical, Health, Psychology, Science, Memoir

242 pages, Hardcover

First published February 7, 2017

About the author

When I started medical school, I had no idea that I would become a writer. I'd completed a PhD in the biochemistry of endorphin receptors, and planned to become a bench scientist with a once-a-week clinic to see patients.

But during residency, I fell in love with patient-care, and realized that I'd have to put bench research aside. After three years of training, I took off some time to travel. I spent 18 months on the road, working occasional medical temp-jobs to earn money, and then exploring Latin America for as long as my money would last.

It was during these travels, during this first true break from medicine, that I started writing down the stories of my medical training at Bellevue Hospital. I had no intentions about a book, or publishing at all, but I just needed to unload some of the stories that had built up over the years.

When I came back to medical practice, writing kept itself going in my life. Then I helped found the Bellevue Literary Review, which was another way to incorporate literature into medicine. Now, my time is split between clinical medicine, teaching, writing, editing, my newest hobby--cello, (and of course my three wonderful children!).

Reviews

[Sadaf Salehi · Rating 4 out of 5]

من نسخه اصلی این کتاب رو نخوندم،
نسخه فارسیش با ترجمه خانم دکتر افروز معتمد رو خوندم که متاسفانه اون نسخه رو توی گودریدز پیدا نکردم که نظرم رو بنویسم، خلاصه بگم :این کتاب بنظر من کتاب بینظیری بود که حتما هر دانشجوی پزشکی باید بخونتش مخصوصا وقتی که تازه داره وارد دوره بالینی میشه و مخصوصاتر توی این دوره اوج تکنولوژی و کاربردهاش در سلامت، خوندنش از همه کتاب‌های غیر درسی پزشکی که قبلا خونده بودم برای من جذاب‌تر بود. یسری نکاتی که برای خودم قابل توجه بود رو اینجا مینویسم جهت یادآوری :

1. هیچوقت با پیش داوری سراغ مریض نریم، شاید اون چیزی که از نظر ما خوبه برای مریض بدترین عاقبت باشه. ما بعنوان پزشک مسئول تصمیم گیری برای بیمار نیستیم بلکه مسئول ارائه بهترین اطلاعات هستیم تا مریض خودش بتونه تصمیمی که ترجیح میده رو با آگاهی بگیره. لازمه اینکار اینه که در هر مورد مشاوره ای قبل از صحبت، سعی کنیم به یه فهم مشترک برسیم و این هم در تشخیص هم در درمان و هم در پروگنوز مطرحه. چقدر از بیماریت میدونی؟ اگه عاقبت این بیماری چی بشه خوشحال میشی؟ سعی کنیم در جلسات ویزیت چند دقیقه گوش دادن فعال و بدون حواسپرتی داشته باشیم، خودمون رو ببریم تو کانتکست مریض و نهایتا با عباراتی صحبت‌هایش رو جمع بندی کنیم و نشون بدیم که حواسمون به حرفهاش بوده. در این مرحله در دادن اطلاعات هم خیلی مهمه که ما درک روانشناختی خوبی از مریض داشته باشیم مثلا طبق ادعای نویسنده نباید خبرهای مهم رو بعد از یه خبر بد داد چون اصولا بعد یه خبر بد ذهن مریض آشفته هست و چیزی نمیشنوه

2. توی این عصر تکنولوژی، از معاینه فیزیکی بعنوان ابزار لمس و ارتباط انسانی استفاده کنیم تا بتونیم اعتماد مریض رو جلب کنیم و رابطه بهتری بسازیم. معاینه کنیم، حتی بی فایده و حتی به غلط!

3. برخورد گشت ارشادی ممنوع! تا حالا فکر کردین آدمهای گشت ارشاد هرچند نیتشون خیر هم باشه هیچوقت نتیجه نمیگیرن؟ چون رابطه شون شفقت نداره و به جای اینکه کنار ما بایست، روبرومون هستن. متاسفانه سیستم پزشکی سنتی هم خیلی شبیه به این قضیه هست. واقعا دلسوز مریض باشیم به جای اینکه دنبال اثبات قدرت خودمون باشیم (دیدی بهت گفتم این دارو رو نخوری اینطوری میشه) خیلی اوقات ما فکر می‌کنیم مشکل مریضای با تبعیت پایین نداشتن آگاهی از بیماری و عواقبشه و هی شروع میکنیم مریض رو وارد اورلورد اطلاعاتی کردن درحالی که این غلطه. همه بیمارای دیابتی میدونن اگه داردهاشون رو منظم مصرف نکنن چه عاقبتی در انتظارشونه، دلیل عدم رعایت معمولا چیز دیگه ای هست که خود مریض اون رو میدونه. درمان رو یه امر اشتراکی در نظر بگیریم و از خود مریض برای پیدا کردن و رفع این مشکلات کمک بگیریم. همین قضیه برای افزایش کارآمدی در دادن اطلاعات درست هم صادقه. معمولا بیمارها با دو سه تا سوال اصلی میان سراغ ما، مهم اینه که همین دو سه سوال رو جواب بدیم نه اینکه نکاتی که در ذهن خودمون مهم هستن رو هی بگیم برای پیدا کردن این سوالات هم میشه از خود مریض کمک گرفت. مثلا: مشکل اصلی شما با دیابت چیه؟

4. به داستان شخصی بیمار احترام بگذاریم. ممکنه ما گاهی با نیت خیرخواهانه بخوایم با بیمار همذات پنداری کنیم و تجربیات شخصی مشابه خودمون رو بگیم. هرچند که تو بقیه موارد (بجز بيماری) این کشف نقاط مشترک تو ساختن یه رابطه محکم میتونه خیلی موثر باشه ولی درمورد بیماری اینطور نیست چون انگار با اینکار ما داریم مرکز توجه رو از بیمار میاریم روی خودمون. تمرکزمون رو بذاریم روی بیمار و بعد با رفتارمون نشون بدیم که تو داستان بیماریش تنها نیست. این هم میتونه با اینوالو کردن خودمون و کادر درمان باشه و هم با ایجاد انتظارات مثبت درمانی در فرد. مثلا بگیم که خیلی‌ها با گرفتن این مکمل (هرچند پلاسبو) درد کمتری رو حس میکنن که این حرف دروغ هم میتونه نباشه و البته که اینجا باید چالشهای مالی مریض هم در نظر گرفت

5. شخصیت بیمار رو به بیماریش تقلیل ندیم. این هم در طی فالوآپ و هم برای یکسری معاینات و پروسیجرهای ناخوشایند میتونه کمک کنه. بیماری که داروش رو سر وقت نمیخوره لزوما آدم بی دقتی نیست! این فقط یه جنبه از این آدم هست و دلایل خیلی متفاوتی هم میتونه داشته باشه. وقتی به رفتارهای یه فرد برچسب هویتی بزنیم، اصلاحش دیگه براش خیلی سخت تر میشه.

6. جلسات ویزیت ما یک نوع جلسه کاری هستن. اونها رو جمع بندی کنیم یعنی بعد از گفتگو و دادن اطلاعات، از مریض بخوایم برداشت‌های خودش رو از صحبت ما بگه تا با دایره فهم و ادبیات مریض هم آشنا بشیم. در انتها هم حتما بپرسیم مسئله دیگه ای نیست؟ کم پیش میاد که مریضها اینجا بحث جدیدی رو پیش بکشن ولی درعوض همین سوال ساده رضایتشون از ویزیت رو میتونه به شدت بالا ببره.

7. نهایتا بدونیم که شیوه پزشکی جدید هیچ کمکی به ما در راستای موارد بالا نمیکنه که هیچ حتی عمل بهش رو هم سخت میکنه. برای رعایت موارد بالا ما به مریض هایی نیاز داریم که با داستان‌های مرتب و کلاسه بندی شده بیان پیشمون و این همون کاریه که میشه برون سپاریش کرد حالا یا به دانشجوهای پزشکی جونیورتر یا منشی یا حتی ابزارهای نرم افزاری و هوش مصنوعی و..

8. یه نکته دیگه که تو کتاب مستقیما نبود ولی بر نظام فکری نویسنده مسلط بود و من از قول یکی از اساتید دانشگاه تهران شنیده بودم: ما مریض نمی‌بینیم که درس یاد بگیریم یا حس کنجکاوی خودمون رو ارضا کنیم. ما مریض می‌بینیم که کمکی به م مریض کرده باشیم!

[Farshad Shahkarami · Rating 5 out of 5]

Fascinating, well-researched, and enlightening.

This book offers the readers really good insights on doctor-patient communication. I think anyone who works as a caregiver in any health profession will enjoy this book as much as I did. :)

[CanadianReader · Rating 2 out of 5]

This is the first of Danielle Ofri's books I did not finish. Normally her books are full of engaging stories from her own clinical practice. Not so here. Most of this read like a dry textbook. Ofri provides stories of doctors and patients to illustrate points about communication in medical contexts. I didn't find any of these "points" new or surprising. None would affect my exchanges with my own GP. Some of the doctor-patient exchanges Ofri described just seemed so ho-hum predictable that I wondered why they were included at all. The writing felt chirpy and cliche. Gone was the medical memoir feel of Ofri's earlier work. I can see I'm in the minority here, but I just wasn't engaged. Glad that I had just borrowed this book from the library.

[Kazen · Rating 3 out of 5]

I'm a Japanese⇔English medical interpreter so when I saw the title of Ofri's latest book I cheered. Doctor-patient communication - she's talking about my life!

Medical conversations are examined from all sides. Is it better to let a complaining patient get their whole litany out at once, or should each point be addressed as it comes up? Can the placebo affect be utilized in conversation? How can stereotypes be overcome? Is it ever okay to lie to a patient?

Each topic is covered with both anecdotes based on Ofri's patients (vignettes!) and research studies. All kinds of strategies to improve communication are covered, from how to listen actively to when disclosing personal details is a good idea. I especially like how the studies are dissected journal club style, with weaknesses pointed out along with the strengths. For example, one study found that doctors that scored low on an empathy test had patients with worse outcomes, but:

Maybe the low-empathy doctors had dismal hygiene and the resulting BO was too distracting for the patients to pay attention to their diabetes. Maybe the offices of the high-empathy doctors offered cloth gowns rather than paper gowns, so their patients weren't experiencing frostbite and thus better able to hear what the doctor was saying. You never know what the confounding factors might be...

As an interpreter I enjoyed the stories and insight but didn't come away with many strategies I can use myself. It's part of the job - I speak other people's words and can't outright change the direction of the conversation. I did pick up some tips, though, particularly how using different wording can change how information is received.

What Patients Say, What Doctors Hear is a trove of information for healthcare professionals, who can expect to learn practice-changing pearls, and frequent patients will appreciate the peek into their doctor's head. If you are not one of those two groups, though, you may want to start with a different Ofri book.

Thanks to Beacon Press and Edelweiss for providing a review copy.

[Tracy · Rating 3 out of 5]

A really honest look at how doctors and patients communicate. Dr. Ofri examines some of the reasons the two often aren't on the same page and how it impacts the care the patient receives. She even throws herself in the mix, describing examples of her own missed opportunities to understand what was really going on with her patient. I admit I liked the case studies more than the description of the applicable research, but they come together to offer solutions for how to minimize miscommunications. For me, it also emphasized that doctors, like everyone else, have different strengths and weaknesses, and the first important piece is to find a good match for you.

[Rachel · Rating 4 out of 5]

This book reviews various research about doctor-patient interactions and the author's experiences with looking at those types of interactions in her practice. It also goes into protocols that have been used to analyze doctor visits in order to come up with statistics, e.g., how many questions did the patient ask, and how much of the visit was devoted to biomedical or psychological or social issues. The book is a bit dry, but it's full of very interesting information. A few takeaways:

- Doctors take over patient interviews almost from the start. They think that the patient will ramble on forever otherwise. Research shows that, if allowed, the patient will talk for just a couple of minutes before pausing to hear from the doctor. I imagine the patient also feels more respected that way.

- The more of the time that the doctor listens, the more effective the appointment is.

- The information patients are given about post-surgical pain medication can cause patients to have better (or worse) response.

- Physician training and patient counseling about how to have the most effective visits can help a lot.

- Unsurprisingly, 15 minutes are just not enough for many appointments. This is obviously not the doctor's or the patient's fault, but the system's. She doesn't go much into that; plenty of info about it is available elsewhere.

And quite a bit more, including how the studies were developed and implemented. There are such interesting lines of inquiry here.

This book would be valuable to patients and doctors alike.

[Susan · Rating 4 out of 5]

This is the 2nd book by Danielle Ofri I've read - this one and also What Doctors Feel: How Emotions Affect the Practice of Medicine and both of them have been fascinating reading. Dr. Ofri gives those of us who only interact with doctors as patients a glimpse into what is happening on the other side of the interaction. In this book, she relates experiences from her own practice and other physicians that demonstrate the problems doctors and patients have in communicating with each other. She also reviews research into the issue of doctor-patient communication and some possible improvements.

I really enjoy reading her books; her writing style is both conversational and scientific depending on what the subject is. I really enjoy the case histories, but the chapters about possible solutions to the problem of doctor/patient miscommunication were quite interesting too. I certainly came away with ideas of ways to speak to my physician when next I have reason to see her.

[Tony Guerra · Rating 5 out of 5]

I found What Patients Say, What Doctors Hear by Danielle Ofri, MD by pure serendipity doing a search of my own audiobook narrator Ann M. Richardson. That my book, How to Pronounce Drug Names: A Visual Approach to Preventing Medication Errors How to Pronounce Drug Names: A Visual Approach to Preventing Medication Errors adjacent to this book, showed there was reader interest in patient self-care. I liked that a physician and pharmacist were next to each other, even if on an electronic shelf. We provide different points of view to improve the patient experience within the current health care system.

Ofri’s approach was to go into complex medical cases and communication mishaps within them. She provides a narrative from the physician’s point-of-view, and patient’s when available. While the book in some ways can speak to both patient and physician alike, the author was put in a position of choosing whether to simplify her language to make it more accessible to the reader, but lose the precision and ethos that comes with exacting high level vocabulary. While there are occasional medical jargon references to procedures and prescriptions, those don’t hamper the reader. it’s the lexical level of the book that may make it a bit of a challenging read from time to time. This is to be expected of the editor of an important literary journal, however, and one can’t fault her for using precision with terms like: promulgating, cogitated, equivocating, enumerated, cerulean, sine qua non, and Sisyphean rather than Zinsser plain language.

Where I think physicians and other health professionals will struggle with the audiobook is that an audiobook is a quite different medium than the printed form. Since this is a Whispersync offering, print and audio match perfectly. With a table of contents in the print book, one can easily skip to a section that catches one’s eye. In an audiobook, often the reader is forced to start at the beginning. A patient or layperson would definitely enjoy the whole story collection. But this book is not written for a busy health professional to skip around. It’s meant to be savored from beginning to end. Ask any academic researcher. They scan from introduction to results, and then if interested, back to the methods. In reading Gary Chapman’s Five Love Languages, I cared first about my wife’s, then mine and skipped to those sections in the audiobook.

I would propose that someone who wants to be efficient with the book, or even teach from it in a semester-long course, start with Chapter 16. This last chapter provides about 10 minutes of a case study with the 20 minutes of thesis akin to an academic article’s abstract and introduction. I would then move to Chapter 4, where Ofri writes about Debra Roter, and her pioneering efforts in studying patient / physician communication that serves as a methods and results section. A research minded health professional would enjoy the solutions to dealing with 300 audio transcripts, building relevant metrics, and how to efficiently help medical students turn the mirror on themselves and their face-to-face communication with patients.

What Ofri proposes, the introspection towards a more equal patient and doctor relationship is certainly part of a revolution, but a necessary one in an outcomes based environment. Ofri uses an analogy of the disruption that came from racial and gender inequality in that the status quo is upset when relationships, such as that between doctor and patient is upset and power shifted.
The book is well researched, the narratives deftly told, and the content relevant to everyday practice across more than just the physician’s office. Notable moments include her writing about her Cello and the art versus science of medicine, the improved pain relief scores of patients with the opioid crisis with conversation and encouragement, and the importance of patients seeing pain medications going into the line. I laughed out loud at Metro Center under Washington D.C., maybe inappropriately, at the Tylenol #5 story, a decision to try the placebo effect on an intractable patient. As a pharmacist I simply appreciated the power of medicine. The meeting of the diabetic patient with her single-minded physician is a bit heartbreaking that someone tries so hard to help the patient only to make her want to leave his care. The story ends up with a happy ending but it is a clear case of seeing a motivator (one who directs) with a patient who wants a facilitator (one who creates an environment to choose her direction).

The book is an important one, a worthy read, but don’t try to read it quickly, it’s very much a teaching book, take the lessons in stride a few at a time.

About the narrator
Danielle Ofri could have narrated the book herself. As a presenter she is engaging, funny, and can hold a crowd’s attention. However, she chose to use Ann M. Richardson for I believe the same reasons I chose her as a narrator. Sustaining a crowd in a 30 or 60-minute monolog is one thing, but to maintain a reader’s interest for nine hours of audio requires a referral. Ann M. Richardson expertly played the parts of physician and patient, making the medical and communicative cases an easy listen.

[Gijs Limonard · Rating 4 out of 5]

Insightful and heartfelt stories, anecdotes and musings on the art of medicine centering on the patient-doctor ritual dance every physician (and patient!) can relate to, written by an experienced internist, an actual clinician and it shows.

[Mia Pags · Rating 5 out of 5]

thought it was great and informative!

[Zaki Emad · Rating 5 out of 5]

Absolute essential reading for healthcare professionals.

"We seem to be evolving from the old-school view that considered communication merely an affable bonus that a few kindly doctors possess. You’ll still occasionally hear that so-and-so is an excellent doctor even though he has a bedside manner that rivals a roll of surgical tape. But increasingly we are recognizing that this is a contradiction: you can’t be an excellent doctor if you have a lousy bedside manner. Communication is not an extraneous perk but rather the bedrock of high-quality medical care. Without good communication between doctors and patients, the chances of achieving effective medical outcomes plummet. "

"If well tended with appropriate respect, attention, and time, this communication will take root, nourishing a sturdy doctor-patient relationship. What can be reaped—easing of suffering, improvement of health, solidification of connection—helps enhance our lives on both sides of the stethoscope."

[Alex Bromley · Rating 5 out of 5]

This book was recommended during a lecture in my first year of medical school, and I now believe it should be mandatory reading for every medical trainee. I heavily annotated my copy—not only highlighting and marking passages I found most interesting, but also summarizing each chapter to easily review its main ideas. I have no doubt this will be a resource I return to repeatedly over the years.

Dr. Ofri, a family physician, masterfully explores the profound importance of communication in medical care—how effective communication is not just a nicety but a cornerstone of optimal patient outcomes. She addresses the tendency of physicians to dismiss and roll their eyes when talking about the significance of communication, as it often feels intuitive or obvious. Yet, the research she presents reveals outcomes far beyond what I would have imagined. For instance, one study she highlights demonstrated that patients who had an in-depth preoperative discussion with their anesthesiologist about post-operative pain expectations required HALF the amount of pain medication compared to those who did not.

The book is meticulously researched, and Dr. Ofri’s approach makes it especially engaging. Each chapter is bookended by real-world stories from her own practice or her colleagues’ experiences, which frame and contextualize the research. This narrative style not only makes the material more enjoyable to read but also ensures its practical relevance to the realities of patient care.

[Eric Shaffer · Rating 4 out of 5]

This book is entertaining and informative.

What I enjoyed most was the author discussing her own actual experiences and those of others. Human relations are the most trying aspect of being human, and I mean that in the gentlest possible way even though the problem is sometimes insurmountable (divorce rates, anyone?).

As a patient myself and a doctor myself (American Literature, not a real doctor), I agree with no reservations that communication between the excessively educated and the novice is a freaking nightmare. Every time I hear myself describing my ailments to my doctor, I cringe at the idiotic lexicon I am faced with: "Yes, doctor, it's kind of aches most of the time, but sometimes, it feels like someone is jamming a pin, no, a knitting needle, right into this place beneath the hubcap on top of where my leg bends." Good luck to us all.

Anyway, the most satisfaction that I received from this book is discovering that some doctors really care about the fact that discommunication (That's right; I made that word up--discommunication is communication that actually reduces understanding) is rampant between medical doctors and patients.

From this book and the research therein, I gather a bit of hope that the next time I am not only in pain, but that my otherwise facile tongue is tied, some doctor somewhere will gaze sympathetically at me and say, "Oh, I know what you mean."

[Kirti Changlani · Rating 3 out of 5]

A book with stories of doctor patient relationship on how doctors can develop empathy, how patients have pains outside just the disease, etc.
Author has mostly shared anecdotes of patients and conveyed some ways to help medical field improve.
She has even criticised how we refer someone dying as "Expired", they aren't products!
Overall, a good pick for those interested in medical stories. I had found this at a clinic

[Dorothee · Rating 5 out of 5]

This should be mandatory reading for everyone in the medical profession. Give this to every medical student! Helped me retrospectively understand some of my encounters with doctors that went wrong, and as a patient, it helps me understand the difficulties doctors may encounter in patient communication and has equipped me with some tools to steer the conversation in the right direction.

[megan buck · Rating 4 out of 5]

I read this for class and have no desire to become a doctor but it was easy to read and informative. I learned a lot about the importance of doctor-patient communication and would recommend this to anyone going into the medical field.

[Jeanne · Rating 3 out of 5]

a bit overwhelming with all the studies but gave much food for thought.I went much better prepared to my des appt this week with a written list of thoughts nd questions.

[David · Rating 4 out of 5]

"The doctor-patient conversation is the most important diagnostic tool in medicine." That's Dr. Danielle Ofri's thesis, which is explored through a combination of her personal cases with patients, interviews with doctors, patients and researchers, and well-presented data. With a cognitive-psychological focus (like her book What Doctors Feel, which I also plan to read), and some touching moments, it's personal and candid, and Dr. Ofri's writing has a fluency and colorful wit in the stylistic vein of Steven Pinker. A book for doctors and patients.

[Cindy · Rating 3 out of 5]

occasionally interesting. great topic but this book could have been shorter

[Ardon · Rating 3 out of 5]

In medicine, history taking is often viewed as something akin to an interrogation exercise - can you rapidly extract the information you need from the patient to accurately diagnose them and decide on a treatment plan?

Although this is ultimately the goal, it is easy to lose sight of the fact that this is still a very human interaction which requires empathy and kindness.

Ofri explores how it is possible to gather the relevant facts from a patient, while also ensuring they feel heard and respected. She emphasises the importance of active listening and the benefits of re-using the terms patients use to describe their various maladies.

Interestingly, the techniques she covered largely reiterate what most UK medical students cover in their first year of clinical training - I suppose this is a reflection of the newfound emphasis on building communication skills up in future doctors. That said, I think this book would be of limited value to most medical students for that reason, as well as one more.

Ofri uses a rather strange anecdotal style which was choppy and not particularly coherent. For example, throughout the book, she always returns to the story of a particular patient at various intervals. I think this leaves readers liable to forget certain parts of the story, having been ushered on to other concepts or narratives before being returned to the story of that specific patient.

Perhaps it might have worked better having dedicated chapters to individual patients and the concepts those stories illustrate. However, I acknowledge that sometimes these clinical anecdotes could illustrate different arguments and concepts which would themselves be best split into different chapters.

On the whole, I am ambivalent about this book - I am not sure I would necessarily recommend it to other medical students, unless they were particularly keen to improve their history taking. Even then, the utility of this book is marginal.

[Courtney Holbrook · Rating 5 out of 5]

Every physician needs to read this book. Dr. Ofri is so humble and intentional about communication. The anecdotes and relevant research were moving and thought provoking. I hope this changes the way medicine is practiced

[Dana · Rating 5 out of 5]

Two chronic medical conditions I’ve had since childhood keep me in a regular rotation of doctor offices. I realize I’m not a perfect communicator as a patient, but I’ve also had a few doctors who weren’t great either, leaving me feeling frustrated, unnecessarily scared, or not listened to. I read “What Patients Say, What Doctors Hear” to get a doctor’s perspective to see if there’s anything I can do to improve these conversations.

Solomon discusses the many things doctors are thinking about and distracted by during a visit that affect how they listen to and speak to a patient, all the vulnerabilities and baggage a patient brings to a visit that affects how they listen to and speak to a doctor, and how good or bad communication affects treatment and outcomes. Particularly interesting was a chapter on how the way disclosure of medical errors (some of which result in death) are handled can either increase or decrease lawsuits and overall financial payouts at hospitals. Solomon is honest in how bad doctors can be at communication, but is hopeful that medical schools can start emphasizing better communication, and she provides specific methods on how to achieve that. Scientific studies and real life patient stories are used to illustrate and support each point in the book.

I can’t think of any obvious flaws to mention, and the only way I think the book could be improved would be to add some summary notes at the end of the chapters or at the end of the book. Overall an enjoyable and enlightening read that has left me with a better understanding of what’s going on in my mind and my doctor’s mind during visits. I’d recommend it to anyone that frequents doctor offices or anyone who is a medical professional.

Disclaimer: I received a free copy of this book in exchange for an honest review.

[Cyndi Beane-Henry · Rating 5 out of 5]

I have found a new favorite author! At least in this book!

I have been saying for years that a physician needed to write a book that addressed the communication needed between a doctor and his/her patient. As a nurse, I am often confronted with patients that tell me their doctor doesn't understand them, that their doctor doesn't listen to a thing they say, that their doctor is in cahoots with big pharma and gets a kickback on giving them drugs and that's why they prescribe medication that doesn't work but keeps them coming back for more visits. And it goes on and on!

Ofri addresses these concerns. And she tells how both physician and patient can work together to come to some wonderful advances in patient care.

I can't praise Ofri enough for writing this book. It should become mandatory reading for all physicians, and medical staff! If we had been required to read this during my years in nursing school, it would have saved me a lot of trial and error before I came to a method that works for me. As I am sure there are many physicians who have read this and felt the same!

I give this book Five Stars.


And a big Thumbs Up.



I also give this my personal Highly Recommended Award.

[Erin · Rating 4 out of 5]

This was a very enlightening book. As someone who has worked in the medical profession and has also been a patient with chronic mystery illness, I had a TON of frustration, anger, and disgust of the complete brokenness of the modern medical system.

This book completely helped me see doctors more fully as human beings, who despite having intimidatingly high intelligence, still have the same struggles and shortcomings the rest of us humans do. Its too easy to forget that.

It helped me see the immense pressure the "system" puts on them which strips them of their humanity. This allowed me to fully let go of my "blame" I had put on all the medical practitioners who I feel have failed me. It helped me truly understand that the issues I had been having with my doctor-patient relationships were not as simple as being either "my fault" or "my doctor's." These are UNIVERSAL issues; they just play out as personal ones.

I can see in retrospect the reasons for the giant gulf I felt between me and my doctors after reading this book, no matter how I tried to get what I needed to get across. It really takes understanding another's perspective to know what is missing in your communications and to remedy that. This book provides just that for specifically the patient-doctor relationship.

Danielle Ofri's book gives me hope that medicine has the potential to come up to speed from the stone ages I feel it has been eternally stuck in. If there are doctors like her who have reclaimed their humanity, put the human connection back into medical care, are showing others how to do this and why its important...well, then medicine is already coming out of the stone ages.

Thank you for writing this book, Dr. Ofri. You are indeed a change-maker, on a societal level and on a personal level. You have certainly helped me positively reshape my story about my medical misadventures.

[Carol · Rating 4 out of 5]

I received this book from a Goodreads give away. Exploring the dynamics between patient and doctor Danielle Ofri discovers that in spite of good intention on both parties doctors don't always understand the meaning of what their patients are saying and visa versa. There is a great difference between listening and understanding. I would urge any patient with chronic or serious disease to read this book and I would encourage doctors to also read it. As a person with Lupus and Rheumatoid Disease this really opened my eyes to changing my communication methods with my doctors which will make the care and management of my disease much less stressful and much improved.

[Kelly · Rating 4 out of 5]

4.5 stars. I’m a medical decision making researcher and I’m using this book as part of background reading for some new research on doctor-patient conversations. Ofri writes excellently and shares very interesting patient stories and surprisingly revealing personal stories of her own failures and mistakes communicating with patients. I’m less familiar with the science specifically of doctor-patient communication than I am with other aspects of medical decision making, so I learned a lot, and the references will be really useful for me in digging more into the literature. Definitely interested to read more of Ofri’s books.

[Sarah · Rating 5 out of 5]

Fascinating, full of compelling stories. In a world where speed and instant access to information are emphasized, lovely to read a book that focuses on the importance of listening and communicating, particularly in the tricky area of healthcare.

[Katie Robles · Rating 3 out of 5]

Some interesting anecdotes, but I expected a less studious approach, perhaps more "how to" on communicating at my next appointment. Good writing but not what I was expecting.

[Kimberly Hughes · Rating 4 out of 5]

This book is about miscommunication between doctors and patients, mostly because of a lack of active listening, but also about tones used, perceptions of expectations on both sides, and terminology issues. It touches on how difficult self advocacy can be and how doctors view it as a negative. It does inspire a lot of thought and gave me an idea for a volunteer organization and gave me ideas on how to deal with my various doctors.

There is also a lot missing in what causes issues between what is wrong with the patient and how that is communication and what the doctors are hearing. For example, there is nothing in the book regarding how two patients may saying the same thing may mean different things for the two. A patient choosing a 7 on the pain scale may be feeling some extreme differences. For me, I have never felt pain where I could not concentrate enough to communicate, even in the final throws of an induce labor without any painkiller. For another patient, a 7 might be hours from delivering with no pitocin in their system.

Another lack would be in the ability to handle pain and heal at different rates. I have a child that had heart surgery. I was told that she would be in the hospital for 10 to 14 days and would be miserable and drugged most of that time. My daughter was released 48 hours later and was rolling around the living room shortly their after. My dad told me that people stay in the hospital longer for the removal of bunions. Even in a single patient, different locations could cause different amounts of pain. My MIL hates when a dentist tells her a procedure is just uncomfortable when it is very painful for her, but she can have a major fall and be bruised all down her leg and say it wasn't painful at all.

There are a lot of other missed opportunities for patient doctor interaction problems. There is also nothing in the book about thresh holds for pain or complaining. The book doesn't cover how a patient does not know what to tell the nurse versus the doctor or whether they should repeat spiels exactly. There is only one line in the book that says that doctors should treat the patient and not the symptoms but that is basically what doctors (at least MDs) think to do. I didn't take notes while reading this, but I know that I was constantly thinking about things the book should cover and then it ended quickly before any of them were covered. Finally, I think the book should really touch on how these 'difficult' patients in the case studies could have gotten their doctors to really listen.

The review feels very negative. I actually feel that there is a lot missing and that there is a lot of repetition. It is laid out well and is interesting to read. I gave it four stars anyway because while reading it I thought that a lot of doctors would benefit from reading it and even thought about passing it to my nine-year-old that has her heart set on being a gastroenterologist. I think it would be best for people when they are first becoming doctors are are still striving to be the best doctors they can be.

[BOOKLOVER EB · Rating 4 out of 5]

In "What Patients Say, What Doctors Hear," Dr. Danielle Ofri cogently analyzes the doctor-patient relationship. Although physical exams and diagnostic tests are important, there is no substitute for taking a complete history and engaging in fruitful dialogue. Of course, time is short in a busy office, but doctors should do their best to address their patients' concerns without interrupting or hurrying them. Why? When doctors dominate the conversation, they may miss vital information. Most patients prefer to be partners in their care, not just cogs in a medical machine.

The author explains the basics of excellent communication: Doctors should do their best to maintain eye contact; ask open-ended questions; summarize key points; and encourage patients to speak out about "what motivates and what challenges them." Patients should consider bringing a short list of questions with them and, as an aid to memory, jotting down the answers. Although it seems counterintuitive, Ofri points out that malpractice suits are reduced and settled out of court more frequently when hospital administrators admit to medical errors made by their staff. Another important factor is bias. Is the doctor dismissive of "difficult" patients—especially those who are demanding or have trouble adhering to a particular regimen?

Ofri offers a host of examples, including some from her own experiences, to illustrate her points. She knows from her own practice how demanding a doctor's job can be. No one expects all medical professionals to be perennially cheerful, patient, and deferential. However, Dr. Ofri would like medical schools to teach communication skills to all of their students. If doctors were to behave less peremptorily and speak more clearly and compassionately to the men, women, and children who rely on them, it would be a win-win for everyone. "What Patients Say, What Doctors Hear" is a thought-provoking primer on how to make doctor-patient interactions more productive.