The power of listening in healthcare

I am a little late in posting this week as I was away for the weekend watching my daughter graduate from college (USC). It was exciting and lovely and surreal all at the same time and, as a Berkeley graduate, I will never feel entirely comfortable on the USC campus just because. But since this was a once in a lifetime kind of experience for both she and I (my only child), I took time off and committed to spending several days in full-time mom mode, not my usual default position.

But it was clearly the right decision. I figured this was my mom ROI coming due and it was also Mothers’ Day weekend – it was time to escape my healthcare bubble and be present. I took time off, I ordered flowers, I purchased balloons, I helped with packing, and I made dinner reservations instead of investments. Maybe there is no such thing (yet) as time travel, but it sure felt like I’d gone from USC drop-off day in 2014 to USC graduation day in 2018 in seconds so I really wanted to pay attention. Is it any wonder that the word “commencement” has a dual meaning that implies both a beginning and an ending all at the same time?

And yet, as I settled into my seat on the expansive lawn at USC to watch the commencement ceremony, it became pretty clear that one can never really escape health or healthcare given how profound a place it holds in the human experience. And what really drove that home to me was the choice of graduation speaker, Dr. Siddhartha Mukherjee, scientist, oncologist and Pulitzer Prize-winning author of Emperor of All Maladies, A Biography of Cancer.

Mukherjee’s excellent speech was not, however, about medicine or health in the scientific sense of the word. He spoke instead of about what he hopes will be an emergence of “Generation L” where the “L” stands for listening. While one of the foremost experts on the science of oncology and related fields, Mukherjee jumped right over what is special about precision medicine and went straight for what is special about precision health: the introduction of empathy and the personalization of medicine based upon really listening to people about what they want and need whether it’s medicine or not.

He spoke about how it took him 8 years after starting a medical practice to set aside his medical brain and actually fully listen to a patient for the first time. In this case, his patient had a cancer which required a strict weekly chemotherapy regimen to be effective, or so science thought. When his patient looked at him one session and said he just couldn’t take treatment that week, that he needed a break and didn’t want to proceed along the same path as previous weeks, Mukherjee said it was a revelatory experience to pull himself out of his normal mode, to “emerge from the closed cordoned off place in his own head,” to hear and respond to the patient after first rejecting the idea on scientific grounds. And when he did open his ears and respond with empathy to what the patient really wanted, the clinical outcome was far better than expected.

Now granted, USC doesn’t always have people who change the world of medical science as their keynote graduation speaker. As Mukherjee himself noted, last year’s speaker was comedian Will Ferrell (a USC alumnus) and “this year’s audience must be wondering how they got stuck with the cancer guy.” But this year USC doubled down on the category, awarding an honorary degree to both Mukherjee and to Dr. Jennifer Doudna, largely responsible for the discovery of CRISPR gene editing technology (GO BEARS!). I guess it takes two field-changing scientists to equal one comic genius. But in the end, you probably need both kinds of people to maximize health outcomes. If you look at my own Twitter feed you will see that I follow a large mix of healthcare people and comedians and that is basically it. So point made.

This act of getting outside one’s own personal echo chamber and listening with intent and with empathy was the focus of the talk and it was powerful. Mukherjee stated that there are three types of listening. One is the ability to really put oneself in others shoes and not just hear but feel their thoughts and what it’s like to be in their skin. Another is the ability to listen to history so one can hear the “rhyme of it” when it comes roaring back so we can act effectively in response. The third is  the ability to listen to nature in order to “eavesdrop on the natural laws of the universe” in order to learn how to use them to our betterment.

Mukherjee spoke about how we have become a society that hears but doesn’t listen, that our nation’s unwillingness to acknowledge facts is fundamentally a failure to listen. He spoke so compellingly about how essential it is to empathetically (if metaphorically) step into the shoes of others in order to advance science itself. For Mukherjee, this ability to get outside of one’s own head and into the headspace of patients is fundamental to moving medicine forward. As one who happens to entirely agree, it was such a refreshing point of view to hear from someone who has spent much of his time in the lab and who could choose to be known only for his contributions to science, extraordinary as they are.

In keeping with his style to blend the scientific and the humanistic, Mukherjee exhorted the audience and especially the young graduates, a sea of 15,000 bachelors, masters and PhD students, to commit to establishing themselves as the “listening generation or Generation L.” He pointed out that the generation before has been obsessed with the technology of hearing (as distinct from listening). It’s pretty clear that he was right considering how many had their iPhones open at the commencement event. The mobile phone/texting/tweeting movement has made it possible to hear anyone anywhere but has put a real damper on listening. I’m as guilty as anyone and it was nice to actually sit there in the weird Los Angeles rain (whoever sang that song about how it never rains in Southern California is a damn liar) with no electronic gizmos in my hand and to listen to Mukherjee’s words.

I have heard tell that the latest generation, that of my daughter, is more open to diversity, more eager to do good not just well, has a more open mind than the few generations that have come before them. I sincerely hope that is the case with the entirety of this age cohort, as my Monday morning return to the real world of health and healthcare makes me realize how important this Generation L concept really is. There is no amount of science that will take the place of human interaction. There is no amount of technology that can replace empathy in its truest form. No robot can put aside logic and decide that it’s ok to spend the extra money on the red roses and better-looking sunflowers because they match the school colors more closely. No artificial intelligence algorithm can replace the role of decisions that seem irrational but may be entirely rational if the underlying personal motivations and psychology were fully known.

I sat there last Friday in a sea of crying parents who were lucky to have their tears camouflaged by the rain. They (myself included) were crying for a wide variety of reasons that entirely contradict themselves – Yay, that parenting thing worked and the kid made it! Oh crap, the kid made it and now will not need me anymore! Yay, I have more time on my hands since I don’t have to wait on the kid hand and foot! Hold on, I like spending time on my kid and doing things for her! Yay, I will not have to pay those crazy tuition bills anymore! Oh damn, if the kid has her own job and doesn’t need my money she will be able to make all her own decisions whether I like them or not! Yay, I get that extra room and I can turn it into a woman cave! Wait, it’s too quiet in the house with her gone – come back to your room – I’ll never clean it again! This human feeling thing is never simple. If we think we can use only science to make good medicine, we are forgetting that people are the recipients.

This is why I never worry about all those tech companies saying they will replace humans when their AI, ML, VR, Blockchain, or whatever the hell takes off. Sure, some jobs will go away but new ones will also be created, as throughout all of history in response to the march of technology. But to think that we can do away with humans in the healthcare context speaks to a real naivete in my view. We may not need as many people doing mundane and repetitive tasks, but we will need empathetic listeners and those who can translate conflicting human emotions and complex social needs into courses of care that actually make people’s spirits better, not just their cells.

And just in case anyone outside of healthcare, say someone in politics, happens to be reading this, the same story goes there. And everywhere. A little empathy goes a long way no matter what world you lurk in. Generation L – a great idea and perhaps open to new applicants who are a little more, shall we say, experienced?!

Photo: Getty Images

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