Dr Rageshri Dhairyawan calls on health professionals to improve their capacity to listen to patients. Published on the front page of the Lancet in February 2025, NHS consultant and researcher Dhairyawan’s essay ‘Reflect, Collaborate and Listen’ draws on some of the key ideas set out in her book: Unheard: the Medical Practice of Silencing (2024).
I grew up in a small village in England, which boasts its own surgery thanks to my father and his practice. There was a strong pastoral element to his and his team’s clinical roles. My childhood recollection of the waiting room was of people chatting and laughing, leaving me wondering if there was anything the matter with them at all. Sometimes, patients would come to the house and seek advice in our front room. Once or twice, they even brought poorly animals. Sometimes he’d receive a phone call and rush out to a remote farm because he’d likely arrive before the ambulance. By listening to his patients and building relationships with them and their families over time, he gained trust and respect, and was, in turn, listened to.
Today the “family doctor,” whose role it is to understand the patient in the context of their family relationship, is less prevalent. As patient demand has increased, families and demographics changed, services expanded, care specialization fragmented, and appointment times shrunken, the very notion of the family doctor has retreated. Whilst there is much to celebrate in the development of primary care in the UK, the reduced capacity, and indeed willingness to listen, has left a gap.
Dhairyawan argues that this gap extends across the National Health Service (NHS). A root cause, she suggests, is a power imbalance between clinician and patient. This is sometimes the result of prejudice flowing from racism, sexism, ageism and other forms of bias. Nowhere is this clearer than in maternity care. MBRRACE-UK (Mothers and Babies: Reducing Risk through Audit and Confidential Enquiries) reports have detailed ‘shocking racial and socioeconomic inequalities’ in deaths of women pre-, during, and post-childbirth in the UK and Ireland. Following a raft of recent reports criticising failures to listen and act on women’s concerns, it remains clear that ‘The NHS is still not listening hard enough to families on maternity care’.
Dhairyawan does not duck the difficult question of what needs to be done. Action starts with medical education, where students should be taught the value of listening to patients and equipped with the necessary skills. This would help counteract the biomedical model, which separates the patient from their social context and focuses exclusively on fixing the broken body. Students also need to be better equipped to deal with uncertainty: to acknowledge and share uncertainties rather than gloss over them or omit them because they cannot provide comprehensive answers.
In practice, clinicians should be more reflective about their listening practices and make it a part of their continuing professional development. The patient’s voice, meanwhile, should be elevated and amplified. In health services, we must prioritize the space for private conversations. In primary care, for example, Dhairyawan recommends that patients should be free to choose to sacrifice swifter access to any doctor in preference for continuity with their chosen doctor, if that is their priority.
Dr Dhairyawan’s book and article are timely. Several policy reports have referred to the devastating impacts that can flow from a failure to listen to patients. This was evident in the recent Infected Blood Inquiry final report into the worst treatment disaster the NHS has seen. Tens of thousands of people were infected with HIV and hepatitis C when they received infected blood and blood products in the 1970s, 80s and 90s. In his final report, the Chair, Sir Brian Langstaff set out lessons for the future. One was that “communication means listening: it is more talking with than talking to.” He went on to say that “there can be no proper consent without adequate communication, in particular of the risks and alternatives, but also so that the care of the patient respects the patient’s ownership of their own body and life.”
Listening to patients should not be confused with simply doing what they say. Clinicians should not offer treatment that is not clinically indicated and in the patient’s interests. What it does mean, as Dhairyawan so eloquently expresses, is that the combination of the clinician’s clinical expertise and the patient’s expertise of their illness and body, will lead to better outcomes and patient satisfaction.
This balance between professional expertise and patient autonomy is reflected in case law on informed consent. In Montgomery v Lanarkshire Health Board [2015], the UK Supreme Court required medical professionals to provide information to patients on material risks and reasonable alternatives that empowers patients to make their own informed choices.
