The 2024 Election Should Remind Us of the Value of Listening to Our Patients

As a critical care physician in the blue-voter state of California, I was initially stunned by the election results. But as I reflected upon the criticism heaped on the Democrats for the loss, I realized that politicians may be like physicians in a key respect: many don’t listen to the people they serve.

After years of working in hospitals from California to Texas to Massachusetts to North Dakota, I am disheartened by the number of times I see golden opportunities to listen to patients squandered. Daily.

Americans stopped many Democratic politicians from taking office in part because they lacked situational awareness. Election post-mortems suggest that politicians didn’t listen to voters’ aggrieved feelings about the price of food, gas, and housing, the immigration issues at the border, and definitions of diversity based on race, ethnicity, and gender rather than class. “We don’t listen enough; we tell people what’s good for them,” tweeted Sen. Chris Murphy (D-Conn.) days after the 2024 election.

I see physicians make the same mistake of failing to listen, and instead making assumptions about their patients. I was asked to see Adelina*, a 95-year-old woman with low blood pressure and confusion, only to find out after a whole 5 minutes — 5 minutes — that she had refused further treatments for terminal uterine cancer that invaded her bowels and bladder for months because she wanted a peaceful death when the time came. I was befuddled by how the admitting physician missed this. When I asked her about it, she shrugged it off, saying, “Oh, I didn’t think about asking.”

Physicians often enact medical knowledge upon their patients without acknowledging that they may be ignoring or harming them. They don’t consider that individual views of health and wellness often reflect aspirations for the future and anxieties about getting through the present. Instead of canvassing support by discussing treatment options that integrate with their complex lives, doctors interrupt patients within seconds, point to a diagnosis, and start prescribing and operating.

Oncologists recommend chemotherapy because a terminal cancer is “treatable” without exploring whether patients would find the treatments too physically, financially, or emotionally taxing. Neurosurgeons perform brain surgery without knowing if patients understand potential consequences like the loss of almost all independence. Intensivists send comatose patients to long-term care facilities where they “linger” — as a nurse once referred to it — without discussing goals with family members until acute illnesses send them back and forth to the hospital in a vicious cycle without escape.

We don’t spend time listening because we prefer “hard” intervention-oriented paths emphasized during our training. We pursue advanced training to do robotic surgery, attend workshops on administering Botox, and dine with pharmaceutical and device company representatives to hear about industry-promoted products. Few, if any, go to “soft” communication courses to enhance empathy and build trust with patients.

Why? Because scalpels, needles, devices, and drugs pay the bills and don’t talk back. It’s way easier to push patients to the operating room, the procedure suite, or the pharmacy than to have emotional conversations about quality of life, death, and suffering. Physicians don’t talk about the experience of illness and dying because they don’t have to — they’re not the ones going through it. Even among peers, physicians avoid saying “death” as if it were a jinx.

Physicians are also convinced that doing their job properly requires detachment. We hold patients’ subjective comments at arm’s length, preferring to stay objective and rational when making decisions. But we have slid down to the slippery slope’s bottom: now we hardly listen at all.

Like many Democratic politicians, we don’t realize how aloof we appear when we dismiss vaccine concerns and expect that our expertise should be welcomed without question. We don’t talk to patients; we talk about them and at them, using cold intellectual logic and waving research papers and credentials from “higher” institutions. People doubt us, fearing hidden agendas. Perhaps here lies the political appeal of Robert F. Kennedy Jr. (RFK Jr.) as HHS secretary appointee: he may lack expertise, but his ability to listen captivates. In contrast, physicians’ inability to listen offsets their expertise and credibility. The result: RFK Jr.’s message resonates more than ours.

We must see patients not as a monolithic group that receives care but as complex individuals who participate in care. Only by listening intently can we personalize care: we must give up what we think is in their best interest and ask them to share what they know shapes it. In doing so, there is a silver lining for physicians to overcome burnout, which affects almost half of us in the U.S.

Re-establishing trust with our patients can help make our work more meaningful. But our first step is to admit that physicians, like our politicians, must listen to others first.

*Patient’s name has been changed for privacy.

Venktesh Ramnath, MD, is an associate clinical professor in the Division of Pulmonary, Critical Care, and Sleep Medicine at University of California-San Diego Health in La Jolla.