Listening in an Age of Abundance
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May 27, 2026
By the time I met her, she had lived with diarrhea for nearly six months. She was 59, a health care worker, and had been hospitalized several times since symptoms began shortly after a left heart catheterization. Each visit added testing and imaging, yet no answers followed.
When we entered her room, she told her story with practiced efficiency. Beneath her words lay weariness, frustration, and guarded disappointment. She had told this story many times before; some clinicians had believed her, others had not. As we moved quickly through rounds, constrained by time and a full census, I sensed her deepest fear: that we would listen just long enough to order more tests, and then move on.
Before beginning residency in the United States, I trained and practiced medicine in Ghana, where scarcity shaped decision-making. Access to imaging and specialized testing was limited, and diagnosis relied on careful history-taking, repeated examinations, and close attention to what patients said and what they struggled to say. Clinical judgment was not a preference; it was a necessity.
Practicing in the United States introduced me to abundant resources: CT scans, MRI enterography, and extensive laboratory panels. I began to notice a subtle shift in my thinking.
Faced with complex presentations, my instinct leaned toward assembling diagnostic checklists rather than spending longer at the bedside. Efficiency was rewarded, while listening, though still valued, was compressed by time pressures and full patient censuses. I began to expect answers from investigations rather than conversations.
It was within this context that our patient’s story returned to the center of her care.
Despite extensive evaluation, her symptoms persisted. Laboratory studies remained unremarkable. Imaging modalities failed to provide clarity. As the days passed without improvement, the unease among our team grew. We worried not only about missing a diagnosis, but about repeating the experience that had left her discouraged. If she were to leave our care without answers, we feared we would simply become another stop in a long and exhausting journey.
It was then that our team made a deliberate choice. Rather than expanding an extensive workup, we returned to her room together: my attending, another resident, and I. This time, we sat down. There was no rush. We asked her to tell her story again, not because we needed more data, but because we needed to understand her experience.
As she spoke, the tone shifted. The guarded frustration softened into openness. She described the toll her symptoms had taken: weight loss, missed workdays, and the anxiety of planning life around access to a bathroom. She spoke not only as a patient, but as a health care worker who understood the system and yet felt invisible within it. In that space, belief itself became therapeutic. By listening empathetically, patterns emerged that had been obscured by fragmented encounters and time-limited visits. The diagnosis, which had eluded months of testing, became clearer through her narrative.
In choosing to listen, we were not abandoning modern medicine; we were practicing it fully. In that moment, professionalism meant resisting the impulse to move quickly and placing the patient’s story at the center of care, especially when systems make it easy to forget.
That encounter reshaped how I understand professionalism in modern medicine. Having practiced in a system defined by scarcity and now training in one defined by abundance, I learned that neither resources nor limitations alone determine the quality of care. What sustains trust, especially when systems are strained, is the deliberate choice to remain present, listen, and believe patients when answers are not immediately visible on a screen.
This was not an individual achievement. It was a shared act of professionalism among residents, an attending, and a system willing to slow down. It reminded us that trust is fragile and cumulative, built not through the volume of tests ordered but through consistent human engagement. For our patient, being heard restored confidence not only in her care plan, but in the health care system itself.
I will carry this experience forward, not only into my daily practice, but into how I teach and learn alongside others. I have since shared this case during didactic sessions as a reminder that advanced diagnostics are most powerful when guided by careful listening. As Sir William Osler observed, “Listen to the patient; he is telling you the diagnosis.”
In an era of remarkable technological capability, professionalism ensures that medicine does not lose sight of the person at its center.
