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  • Power of Listening: The First Lesson Psychiatry Taught Me

    Power of Listening: The First Lesson Psychiatry Taught Me

    Dr. Najmun Riyaz

    I thought of myself as being relatively patient and a good listener by nature. But when it came to my professional life, I didn’t think listening was one of the skills needed to be a caring physician. As a provider, I believed that I should always do something for the patients to make them feel better. I had this urge, a need, to fix whatever problem they were dealing with at that time.  And if I was unable to help them or did not have an answer to their questions, it felt like some sort of betrayal of my profession as a physician.

    With that mindset, I began my residency in Psychiatry. I may have been able to feel pretty satisfied while going through rotations on medical floors in internal medicine, or ICU setting, neurology, or even emergency medicine. During these rotations, I got numerous chances to fix hundreds of patients’ problems by obtaining a good history, a thorough physical exam, doing the blood draws, ordering medications, checking their imaging, and or finally coming to the right diagnostic conclusion. Every day felt gratifying, as I got to fix something or the other. Most of the time, patients did get better, and that felt like an accomplishment!

    But it was during my second year of residency, when I began my first psych rotation on an inpatient psychiatric floor, that my excitement faded in not just one week, but in only one or two days. I was thinking to myself, “What! No blood draws? No imaging? Not many tests to order?” Even history taking was mostly asking open-ended questions. As is the case with many severe psychiatrically ill patients, some would not even answer these questions. Either they were mute due to some form of catatonia or too psychotic even to establish a stable human connection. Some were indecisive due to severe depression or just didn’t had one right answer. There were so many other challenges of history taking as well. Later in my rotation, I realized that history taking is a skill in our field that takes months to even years to learn.

    Rounding on every patient and asking them questions and pretty much reassuring and “listening” was how most of my days during that psychiatric rotation ended—then having treatment teams, sitting back, and doing some more “listening”. Family meetings also involved being patient and “listening” keenly and emphatically. It would get dull most of the days. The only respite was that I got to get home by 5 o’clock to be with my infant daughter, my main reason for choosing to become a psychiatrist, as opposed to a surgeon, which is what I had intended to get trained in during medical school back home in Kashmir. As an immigrant, I did not have the privilege of having a family close by and had to rely mostly on babysitters to care for my daughter. Plus, my husband being a cardiologist, whose working hours were more than 16 to 18 on some days, choosing a medical field where I could spend time with my daughter was more of a priority than selecting the specialty I had a better liking for.

    And psychiatry happened to be one of the very few fields where a resident physician could have a balanced life, be able to get trained while caring for their young children.  It was purely my choice, which I had made with keeping my family’s needs in view. 

    Those first few months were pretty hard. I would often debate whether I should consider a switch to a different field. Still, every day it was that privilege of being home on time to take care of my daughter’s needs. My overnight calls were also much less in frequency as compared to my peers from different specialties. I was so grateful to be able to watch all my daughter’s milestones. That ability to spend time with my daughter, take her to the park,  read to her, give her baths, etc., is what kept me going during my training on becoming a psychiatrist. 

    During one of my outpatient rotations, we were assigned a few therapy clients and a supervisor, who had a psychotherapeutic background, to mentor us with this part of our training.  And mine was a psychiatrist who was trained in psychoanalysis as well. He was pretty Freudian in his outlook. Very thorough and a kind man. I had to read to him my therapy notes, and then he would give me feedback. I loved those supervisions with him, cause he forced me to think about every word that was said to the patient. That felt like work and felt good. In one of those sessions, he made me aware of this immense need to make the patients feel good, or this urge to give advice or a tip about how they can handle certain stressful situations or come out of the state of sadness or anxiety.  So he asked me one day, “Where does that urge come from?” 

    “I don’t know.” I told him, ” Maybe we physicians are born to make our patients feel good?” I further added. Then he asked me why I choose psychiatry. I gave him an honest answer. He asked if I had not moved to America, what specialty would I have decided to get trained in back home? Without a second thought, I said, “Surgery!” That was my first love back home. I loved to assist the surgeons in my medical schools. Even more, I loved to pull those sutures. It felt like I did something. I was able to achieve something or get something done. That was my mindset then, to fix things to make others feel better. 

    And then he slowly taught me the value of “just listening” to my patients, the power behind this unsaid action. And believe it or not, it indeed is one of the most challenging acts to do. To do nothing but just listen! He taught me that at times it’s ok to give advice, but the real benefit of therapy comes from just being there for our clients. Just listening to what they want to share. To be able to make them feel heard,  even without saying anything in return at times. He taught me whenever I feel an urge to say something, say, “ I hear you,” or repeat back what the client is trying to tell you to make them feel validated. 

    That was the first and the best thing my profession taught me. To listen, and to this day, I always try my best to get better at it. It has helped me in every walk of life, in all my relationships, even with raising teenage children. However, I have to admit it can be hard to be a good listener for our children when we have this strong urge to correct them and give them advice, but I keep trying. I hope we all can feel the power of this underutilized action, and get better at listening to our friends, our patients, our children, our parents, and our colleagues. And we will be surprised how many connections we will make, long-lasting, sincere connections. Wholehearted connection. No wonder this quote from Dalai Lama is one of the wisest quotes to live our lives by. He says, “ When you talk, you are only repeating what you know; but when you listen, you learn something new.”   

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