Tuning out 'noise' to listen to patients

As a midwife, I pride myself on listening to women. I'm a strong believer in intuition and self-awareness. But lately I've been feeling overwhelmed with overbooked schedules and crowded waiting rooms.

I'm weary from pregnant patients begging me to get them out of work on disability at 12 weeks gestation because of “emotional stress.” I'm exhausted from 35 year-old patients who complain of painful or irregular periods and request a hysterectomy without considering the non-surgical or less invasive procedures available. 

All of this noise drowns out the voices that I need to hear, and I have to remind myself to keep listening carefully to women. 

I recently saw a young woman for her annual exam and found a large breast mass. The mass felt like a benign cyst and since she was in her mid-30s, I was not particularly concerned. I did send her for a diagnostic mammogram and ultrasound, which is protocol in our practice. 

Though I tried to reassure this woman that it was not a STAT exam, she was very concerned and rushed to get her imaging done that same day. She said that she had a bad feeling that something was really wrong with her.

The lump that I palpated was indeed benign — a fluid-filled cyst of little concern. However the mammogram showed a small area on the same breast suspicious for malignancy. Subsequent biopsy revealed breast cancer.   

Sometimes it's medical technology that interferes with out patient interactions. A few weeks ago I had a full-term pregnant patient who came in to the hospital three times in one weekend. She was worried that she was leaking amniotic fluid. 

The patient's story was very convincing, but each time every medical test we performed ruled out membrane rupture, so we sent her home. She came in a few days later with little amniotic fluid and a fever. Both mom and baby were fine, but it appeared that her membranes had been ruptured for a while. I'm not sure when her water actually broke or what we could have done differently, except listen more carefully to the patient and her concerns. 

These two incidents reminded me of the importance of listening to my patients. Sometimes the facts of medical technology do not communicate the whole story a patient is trying to tell us.

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