Danielle Ofri

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 show more 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. show less

This book is all about conversation, a key diagnostic tool whose value is often not appreciated. The medical system revolves around efficiency and quality indicators and tests that have quantitative values attached to them, but it is in open-ended questions and active listening that the real work happens. Dr. Ofri showcases this with examples from her own practice and from others around the world about the power of conversation to save money (not ordering expensive, unnecessary tests), make show more connections, and even stave off lawsuits in situations of medical error. As always, Dr. Ofri writes movingly and honestly—she is not afraid to hold up events from her own past and examine her biases in order to improve and grow.

I think this book would pair nicely with with Kathryn Mannix’s book Listen: How to Find the Words for Tender Conversations. show less

Medicine, wherever it is practiced, involves heavy things that are not for the faint of heart. Outcomes sometimes involve death, and errors are not always (or often) easy to spot. Poor outcomes can haunt doctors and nurses both professionally and personally – almost as much as they can haunt the families of patients. Nonetheless, in the United States, no comprehensive system exists to monitor medical errors. As Ofri details in this well-written and timely book, this situation neither show more provides justice to the needs of patients and their families nor allows the medical system to learn from its mistakes.

This book probes two medical cases that were particularly error-filled. One involved a patient with leukemia, a form of cancer, and the other involved a patient whose case was clearly mismanaged at several points. Errors accumulated in each case, and each was met with silence and obfuscation by the medical establishment. At the outset, positive outcomes were not guaranteed, but compounding errors guaranteed horrific outcomes involving death. Families of both patients sought corrective measures for the causative systemic problems, but despite noble intentions and proper efforts, neither family were successful.

Ofri holds the Danish medical system as an example. In this small country, parliament passed a Patient Safety Act of 2005 to set up a system that judges and potentially compensates patients for negative outcomes. Gone were the excesses of legal case and drama of the courtroom; also gone were the huge settlements for hyperbolic cases. In its place was something more equitable and more enlightened. Instead of requiring excessive, provable harm like death or permanent disability, the Danish system just required preponderance of the evidence for more mundane claims.

The author rightly questions whether such a system could ever succeed in the United States. For one, we are more brashly capitalistic and individualistic than Denmark. Further, our country is much larger and more diverse. We also have a long and deep suspicion of centralized medical data collection. But the Danish system simply seems fairer and more just to both parties. In it, the doctor-patient relationship never transforms into an adversarial duel filled with legal tactics. Medicine at its best aims to be humane; doesn’t this system better fit that ethos?

This work can find an obvious home among American healthcare workers, whether doctors, hospital administrators, or nurses. Particularly those with patient contact should attend to Ofri’s clear message. Policymakers and administrators of public health might also want to give this one a read because of obvious import into government. Ofri’s call may yet be a bit early for legislation to be passed, but my experiences concur that it needs to be heard. It deserves to be on the radar for public health advocates once the challenges of COVID dissipate. I’m glad that I found and read this book. show less

The latest book by Danielle Ofri, an internist and professor of medicine at NYU, is her best yet. It centers on the doctor-patient relationship, "the single most important tool of medical care", and features Dr. Ofri's relationships with several patients of hers, along with a remarkable Emory University student and her physician, the different barriers that affect these relationships, research about effective communication, and, most importantly, tools that both physicians and patients can show more use to enhance their relationships. This book made me reflect repeatedly, think about my own successes and shortcomings in my communications with patients and families that I like and respect, and especially those who I find difficult and dislikable, and it will undoubtedly affect my approach to all of those who fall under my care. I received an advance review copy of this book from LibraryThing, and it will be available to the general public on February 7 of next year. I highly recommend this book to all health care professionals and patients, i.e. everyone. show less