COVID-19 didn’t stop the Listening Lab team from engaging with people wanting to tell their stories.In medicine — as with much of life — listening matters.
Consider Teya Sepinuck. A few years ago, when checking in for a procedure, her nurse sat at a computer with her back turned when asking her two standard but personal questions (if she’d been the victim of abuse or felt depressed). Sepunick replied “no” but told the nurse even if the answer had been yes, “I wouldn’t tell you because I don’t feel like you care…. I left there thinking, is this really how we ask vulnerable people traumatic questions about their lives?”
Then, at another visit, a nurse asked her the same personal questions but gently and with sensitivity. Although Sepunick didn’t remember, the nurse identified herself as the one who had previously seemed so uncaring and apologized for her past behavior. Sepinuck wrote down and recorded this experience as part of the Penn Medicine Listening Lab — and it also helps to show why the Listening Lab exists. “It gave me a lot of hope about the possibility that even just giving feedback once, somebody may change.”
Studies show that the simple act of listening seems to have taken a back seat in clinical care. An article in the Journal of General Internal Medicine showed that in almost 70 percent of studied encounters, the clinician interrupted the patient after a median of just 11 seconds. Another article, in Health Affairs, found a majority of the patients they studied reported having interactions with providers that lacked compassion. While advances in research and technology have benefitted patients on many levels, these changes have also resulted in the loss of some of medicine’s “humanity.”
But the pendulum is slowly swinging back to an environment where listening and sharing experiences —and learning from them — are moving to the foreground. At Penn Medicine, the Listening Lab is proving to be an important part of that transition.
What is the Listening Lab?
The Listening Lab is an online storytelling initiative that embraces the simple act of listening and sharing, and advocates for the power of listening as a form of care. The website (pennlisteninglab.org) is home to a growing library of audio stories written and recorded by Penn Medicine staff, providers, patients, and caregivers that bring to life important experiences and reflections on aspects of health care that aren’t always discussed. Launched in 2019 under the sponsorship of the Patient Experience Leadership Team at Penn Medicine Academy (PMA), its goal is to gather and share stories about the importance of being present, nurturing compassionate relationships, and empowering communities. “It is grounded in the understanding that it can be empowering and therapeutic to hear and feel heard by another,” said Stephanie Kindt, senior consultant of Penn Medicine Experience.
Aaron Levy, PhD, of the University’s School of Arts and Sciences, and a special advisor for health and humanities initiatives in PMA, created the Listening Lab and collaborates with Kindt and Sepinuck — a member of HUP’s Patient and Family Advisory Council — as well as a planning committee comprising members from throughout Penn Medicine to continually expand its impact.
Levy and Sepinuck collaborate with story tellers to first record their stories and then edit down the narrative to a 3-to-5-minute segment. The final version is reviewed by a team of patients, caregivers, staff and providers from across Penn Medicine and receives full consent from the contributor before being uploaded to the site. The final version includes two versions: a version read aloud by the contributor and a transcript.
Although the initiative initially included a physical exhibit that traveled through the Health System, with COVID, its primary “home” is now online. So far more than 28,000 people from across Penn Medicine and throughout the country have listened to the nearly 50 stories on the site. “This is a moment in our lives when we all desperately seek opportunities to share what we are experiencing, in the privacy of our lives, with others,” Levy said. “This lab is a vehicle — a resource — for both self-reflection and connection with others.”
The Ripple Effects of Listening
The stories have become a stimulus for conversation and exploring vulnerability but, beyond that, said Jeff Millstein, MD, of Woodbury Internal Medicine, “we’re hearing how impactful it is to tell the stories.”
Stories by providers convey the “complexity, trauma, and suffering that is part of the lives of those in hospital,” Levy said. In “Will You Pray for Me?” Jason Han, MD, cardiothoracic surgical resident, speaks about an ICU patient he had grown close to but who does not have a good prognosis. Knowing the consequences, she asks him to please remove the intraaortic device that is keeping her alive but not letting her live her life as she wants.
Han describes how he felt as he removed the device (“I was terrified she would pass away right before my eyes, from the very action I had just performed.”) and how during the next hour, as he firmly pressed on the device’s exit point to stop the bleeding, he witnessed the joy of the patient and her two sisters, as they sang gospel songs and laughed together. As the hour came to an end the sisters prayed. “In more ways than physically I felt connected to her that spiritual afternoon. For the first time in my life, I, too, closed my eyes and prayed for her to thrive and to be at peace for the remainder of her life.” The patient left the ICU two days later and died at home the following day.
Telling his story has made Han feel “more confident about being able to share vulnerabilities with my colleagues. More and more residents are comfortable coming to me with their own stories,” he said. "In many ways, I look at this Listening Lab opportunity as an antidote to the culture that we've created in medicine. It would be a long and isolating road without the ability to share with colleagues. That’s the most important aspect of storytelling for me. It forgives being vulnerable.”
In “56 Days,” Mathew Beshara, MD, an obstetrician and gynecologist at HUP who contracted COVID, sees medical care from a patient’s point of view. “I wish someone had told me that your patient might be looking at you but be interpreting things very differently… having that understanding as a treating provider, that the experience you're trying to give to a patient may not be the experience they're actually getting.”
Some stories, like “I’m a People Person,” — shared by Teresa Bullock, a PPMC employee in Environmental Services — give voice to those whose jobs contribute to the patient experience, but are rarely recognized for their impact. Others tackle broader issues. In “We Run,” Anish Agarwal, MD, of Emergency Medicine at PPMC, talks about the epidemic of violence in Philadelphia that’s bringing so many young Black men into the ED and the devastating impact on the entire trauma team who rush to save their lives but sometimes cannot.
“Clinicians and staff witnessing suffering and trauma — it affects them profoundly. Stories help them process and work through their feelings,” Levy said.
Spreading the Impact
Listening Lab stories are making an impact throughout Penn Medicine, on many levels. They’re shared in meetings and huddles, in leadership events, and in systemwide celebrations, such as Safety Week. They appear in the COVID-19 CEO email updates, which go to all employees, and Penn Medicine Together, which offers resources and strategies to help employees cope with anxiety and stress.
At Penn’s Perelman School of Medicine, the stories are an excellent teaching tool to build a skill set of listening, said Millstein, who, with Levy, uses them as part of several Narrative Medicine electives they have taught. “It’s a great demonstration of clinicians and other medical professionals showing vulnerability, which is not easy to teach and not always demonstrated in clinical rotations,” Millstein said. “It fills a void in their training — teaching students to appreciate patient stories as stories, not just medical history. It makes medicine more fulfilling.”
“What we’re doing is not much different than what the Listening Lab is advocating — using stories to facilitate conversations, communications among team members, and, in a more gentle way, engage in complicated discussions,” Levy said. “There’s inherent value to creating a safe and comfortable environment where people can develop and refine and hone their skills listening to one another.”
Nursing orientation at HUP uses Listening Lab stories to help make the patient experience more visible but also to “let new staff understand that they’re not alone,” said Karen Anderson, MSN, PMHCNS, clinical nurse specialist in Patient-Family Centered Care.
In “My First COVID Patient,” Cyra Uy, a nurse at Lancaster General Hospital, describes how frightened she was treating her first COVID patient. “The nurse felt she was alone in her fears, but the story resonated with every nurse who cared for a COVID patient,” Anderson said. “I think the stories make you realize you’re a part of a much bigger world and there’s more support in that world – and more opportunities to provide support for each other.”
Read and listen to more stories and reach out to record your own at https://pennlisteninglab.org/stories.