“For those who are striving to be heard”
The book starts with this dedication and it is at the heart of every sentence throughout; how to ensure patients and doctors are better heard. The author, Dr Dhairyawan is an experienced consultant and medical leader in HIV, dedicating much of her career to researching and tackling health inequalities. She has also experienced being a patient in the NHS, feeling isolated and having her pain downplayed by those looking after her. This allows her to talk from both “sides” of the fence, as it were, to show how important compassionate healthcare is for those that work in it and those that experience it. It is a fantastic guide for healthcare leaders on the importance of compassionate leadership and how leaders can foster a better listening environment.
As healthcare professionals, it is often easy to concentrate on the symptoms that fit into our narrative of the disease process, leading to us to only listen to those symptoms which we feel we can “fix” whilst dismissing the symptoms which may be impacting patients the most. In this way, patients can feel unsatisfied at the end of consultations and even reluctant to return with important or evolving symptoms. This book, in its compassion-first style, reminds us that the patients’ perspective and the impact the symptoms are having on their lives are just as (and sometimes more) important than the clinicians’ agenda.
In seven well defined chapters, Dr Dhairyawan explores how patients “are silenced” due to factors like shame, stigma and feeling dismissed. Consideration is given to the reasons why doctors “don’t listen”, addressing factors such as compassion fatigue, the time constraints and general set up of appointments and staff wellbeing. A chapter is dedicated to exploring when doctors “aren’t heard”; how there is still work to be done on diversifying healthcare leadership and how imperative it is that healthcare leaders and organisations put equity at their heart; encouraging mentorship schemes, scrutiny of recruitment practices to ensure they are unbiased and looking at what individuals can do as active bystanders. It also reminds us of our individual influence on those around us, encouraging us to reflect on our own listening practices, including small examples of “bringing others up” by chairing meetings in a way that ensures all voices relevant to the issue can attend and allow every voice to be heard.
After a deep exploration of the impact of individuals not being listened to, the book moves onto the wider implications of this, highlighting how research is often based on binary measurable outcomes such as whether the patients’ blood count improved or not rather than qualitative research which leaves more space for the exploration of lived patient experiences. The author accepts this is due to both practical and evidential hierarchy reasons but offers a clear call for more research to be conducted with patient led outcomes as the main measure, establishing a solid knowledge base on how diseases impact patients themselves and ensuring the treatments are aimed at improvements in quality of life. The book also highlights that more often than not, researchers study in a field that is important and relevant to them, making it clear that there needs to be a push towards further inclusivity in research to ensure conditions that impact marginalised populations are given the funding and time they deserve.
To emphasise the impact that patients can have on their own care when empowered, a fascinating chapter is dedicated to the fight for justice in HIV treatment with how stories of patients with HIV have changed the landscape on medication accessibility. A moving example of patient leadership is the work of organisations such as ACT UP, a patient-formed group of activists who, through collaboration with government and pharmaceutical companies, brought in things such as safe needle exchange, influenced policies and support for those living with AIDS, and changed the definition of AIDS to include it impacting women. By learning about historic efforts such as these, both patients and healthcare professionals are reminded of the power of patient education, collective action, perseverance and community leadership.
At the end of each chapter, the book summarises the chapter and contextualises it into real world scenarios, giving ideas on how the previously discussed issues can be implemented in practice. These ideas are helpfully categorised into ideas for patients themselves, healthcare workers as individuals, and the broader policy makers and managers/institutions. For me, this is where the book excels as it allows for self-reflection at any stage in a healthcare leaders’ journey. In this way, I would have appreciated more coverage on practical ideas of how to implement the listening ethos the book is centred on.
The book itself is available in hardcover, paperback and audiobook, meaning it can be digested in small segments and in busy lives. This is a book I believe that healthcare leaders and anyone who has face to face patient contact should read every few years, when the difficulties of the job mean compassion and listening can slip down the professionals’ priority list. We’ve all been there but this book offers a concise reminder that we can all do better, listen better and lead better to make every consultation and every encounter a shared mission for better patient care.
Book reviewer
Dr Sarah Carlton
Dr Sarah Carlton is a GP Trainee in the North East of England. She has an interest in compassionate medical leadership and has been appointed the North East Lead for the Faculty of Medical Leadership and Management’s Trainee Steering Group.