Prescription for Doctors: Listen to the Patient’s Story

One gripping story in “Telltale Hearts,” his up-to-date autobiography, is about the author’s great-uncle, Aladar, a Hungarian Jew who was drafted to fight the Russians in 1916 and spent months in the trenches, shooting, being shot at, and waiting.

Russian troops launched an offensive that fall that overwhelmed the Austro-Hungarians. At one point, Aladar found himself on his back, staring at a huge Russian soldier about to plunge a bayonet into his chest.

Their eyes met, and the Russian looked at Aladar as if he knew him from somewhere.

“Are you a Jew?” he asked. Aladar did not answer, so the Russian asked again. In Yiddish.

This time Aladar nodded, and the Russian looked around, winked, pulled him out of the trench, hugged him, kissed him, and told him he would take Aladar prisoner and protect him until the war was over. And he did.

What is this war story doing in a book about a safety-net hospital that treats destitute patients in San Francisco? For author Dr. Dean-David Schillinger, the moment of recognition, of seeing oneself in the other, is a critical part of healing.

One of the biggest complaints about doctors these days is that they don’t have enough time and don’t really listen. That’s why Dr. Schillinger, a primary care physician at Zuckerberg San Francisco General Hospital and Trauma Center, wrote a book about the importance of patient stories. He writes about the power of storytelling to build trust, breaking down the barriers that often separate doctors and patients, ultimately improving care.

“What we’re increasingly losing as our technology advances, as we exploit electronic health records that make us look at the computer rather than the patient, and as we become more and more constrained from a time perspective, is the most vital and common medical procedure — the medical interview,” Dr. Schillinger told The Recent York Times.

“A lot of people think it’s the doctor bombarding the patient with questions, but it really shouldn’t be that way,” he added. “It really should be about getting the patient’s perspective on the experience and its social context.”

The science is key, he said, but the patient story is a necessary complement. “It’s when we separate the two that we get into trouble,” Dr. Schillinger said. The book is about what he calls “the alchemy of science and history.”

His book is like a medical version of “One Thousand and One Nights,” in which the author describes a woman who, despite negative mammogram results, experiences severe, unexplained breast pain; a diabetic whose blood sugar drops so rapidly that it almost kills her; and a man who crawls on his hands and knees for no apparent medical reason.

At one point, he becomes so frustrated with a man who isn’t taking his blood pressure medication that he threatens to “fire” him as a patient. Another time, he drives to the low-income neighborhood where a longtime patient lives to find out why she’s not showing up for cancer treatment.

Dr. Schillinger writes that the roots of most of these problems are not medical. They are rooted in social and economic problems that medicine alone cannot cure.

Ultimately, though, “Telltale Hearts” is about an emerging field of medical research: the ways in which socioeconomic factors like poverty, racism, and marginalization — as well as related issues like food deserts, housing insecurity, and exposure to pollution and violence — shape the health of many Americans, and society’s responsibility to do better.

In 1991, in the midst of the AIDS epidemic, Dr. Schillinger began working at San Francisco General Hospital, a hospital that served as a resource center for the city’s destitute and homeless.

He became a primary care physician there in 1994 after caring mostly for insured middle-class patients during his residency at the University of California, San Francisco Medical Center.

“At San Francisco General, my patients were simply dying at a much faster rate than at University Hospital,” he recalled. “But I was the same doctor for both of them. And they had the same illnesses. Something was wrong. So what was going on?”

The phenomenon was first described in 1971 by Dr Julian Tudor Hart, who was practicing in Wales. While Dr Tudor Hart worked 12-hour days, six days a week, caring for a low-income population, his colleagues who treated affluent patients finished work at 5 p.m. and had weekends off.

Dr. Tudor Hart’s research into this disparity led to the law of inverse care: doctors in poorer neighborhoods are always busier, and ultimately the people who need care the most are the least likely to receive it.

In his own hospital, “health care meets social reality,” Dr. Schillinger said. “We see the end results of marginalization, which manifest in physical disability, pain and suffering.”

Dr. Schillinger weaves his own family saga into the book—his father was a Holocaust survivor, and he nearly dropped out of Ivy League medical school. He even includes his own experiences as a unwell patient who fought to get doctors to listen to him.

The book does not hide the toxicity that can occur in the workplace of medical personnel.

Dr. Schillinger is candid about the callousness that can develop among those working inhumanely long shifts in overloaded emergency departments. There, the doctors he trained with early in his career called patients who came in at the end of their shifts GOMERS—people they just wanted to “get out of my emergency department.”

The book is a call for social change and a plea to the profession “to see the patient as one of us, not just someone to be taken care of and moved through the healthcare assembly line,” Dr. Schillinger said.

“It’s about finding our common humanity in a world that constantly pressures us to take shortcuts and rely on impersonal ways of dealing with elaborate human problems,” he said.