Medicine and the art of listening

As a doctor working in emergency departments across Kerala, I have learned that consultation rooms are full of stories, but the storyteller is not always the patient.

A young woman once arrived at the emergency department accompanied by her father-in-law. He explained that she had a urinary tract infection. He also offered another explanation: she had been unable to conceive.

The two ideas appeared unrelated, but he seemed convinced they belonged together. The patient sat quietly beside him. Then his phone rang.

As soon as he stepped outside, the woman confided in me that intercourse had been painful from the beginning of her marriage. It soon became clear that her husband had a basic misunderstanding of female anatomy and had been attempting intercourse incorrectly, leading to pain and recurrent urinary symptoms.

The problem was not a complex medical condition, but a gap in basic sexual education. And it came to light only when the patient was finally able to speak for herself.

I still think about that encounter because of how quickly someone else’s interpretation began to replace the patient’s own story.

Teenagers often arrive with worried parents who are eager to explain their symptoms and to diagnose them before the young person has spoken a word.

Once, a 15-year-old came in with “migraines from too much phone”. When his parent stepped away to buy medicines from the pharmacy, he whispered: “I’m being bullied at school. I can’t sleep.”

Headaches are attributed to excessive mobile phone use. Fatigue is blamed on late nights of scrolling. Sometimes these explanations are right. Often they are not. Yet what strikes me is how readily the patient’s own experience can be overshadowed by someone else’s certainty.

The pattern appears in subtler ways too. When children arrive with both parents, it is often the mother who remembers the details: previous admissions, allergies, medications, vaccinations, and follow-up visits. Yet fathers, despite being caring and concerned, sometimes answer first, occasionally contradicting the person who knows the history best.

Once again, the consultation becomes a reminder that the loudest voice in the room is not always the most informed one.

Then there was the young mother who came to the emergency department with a bleeding scalp wound after a fall that morning. I remember her distinctly because she was barely in her twenties and already had two young children.

By the time she arrived that night, the wound had already begun to close on its own. She told me that she had delayed seeking treatment because there was nobody to look after her children.

As we spoke, I realised that she had never visited a hospital alone. Her husband had always accompanied her and usually spoken to doctors on her behalf. On the day she fell, he was unavailable until night, and so she waited.

Unlike some of the other patients I have described, nobody was speaking over her. Yet the habit had already taken root. Somewhere along the way, she had learned to silence her own needs and trust others to speak on her behalf.

These encounters may seem unrelated, yet they point to something larger. In India, illness rarely belongs to one person alone. Families accompany, advise, interpret, explain, and sometimes even speak on behalf of those who are unwell.

To be fair, this can also be a source of tremendous strength. Yet support can sometimes become substitution.

A patient may be physically present while their story is filtered through a parent, spouse, child or in-law. Details are embellished, assumptions are added, and explanations rooted in culture, hierarchy, half-understood science or long-held beliefs begin to take shape. Occasionally, the most important fact in the room remains unspoken because the person who knows it best has not been given the opportunity to speak.

Medicine is often described as the art of listening. But before a doctor can listen, the patient must first be heard.

Some of the most revealing moments in my practice have occurred when a relative steps outside to answer a phone call, collect a prescription or when I ask them to wait outside. The room becomes quieter, the patient relaxes, and a different story emerges. It’s not a new illness, necessarily; just the patient’s own version of it.

And that story is often the one that matters most.

That young woman, once her father-in-law stepped out, reclaimed the right to describe her own body.

In a country where family is often the first and final authority, perhaps the most radical act in a consultation room is simply to ask the patient first.

After all, symptoms are best described by the person who feels them.

iammariak123@gmail.com