Listen to My Heart: Really Hearing What the Patient is Saying
Meggan Connell UCD School of Medicine, University College Dublin, Belfield, Dublin 4.
Karen Mulligan UCD School of Medicine, University College Dublin, Belfield, Dublin 4.
We all think we know how to listen, but there is a difference between hearing people talk and listening to what they’re saying. Let’s imagine a Monday morning half way through the semester. You have big plans for the week; review all the lectures, start and finish several assignments – in other words, get on top of things. Between your first and second lecture you run to grab a coffee with your friend Orla, chatting on the way to save time. You ask how her weekend was but your mind is multi-tasking: half listening, half thinking about how much you need to do later and how you can possibly fit it all in. “Oh it was fine,” she says, “I didn’t get up to much.” You don’t think anything of it. You go to class together and your week carries on, busy, busy, busy.
Orla isn’t really fine though. Her weekend wasn’t fine. What would have happened if you had taken the time to quiet your thoughts for a moment when you asked her how she was? What if you had observed her body language and listened to her tone of voice during your chat? These non-verbal cues may have helped you realise that Orla didn’t actually mean her weekend was fine. You could have asked, “Is everything okay, is there anything you want to talk about?” That is active listening. Active listening, at its very core, is making the choice to listen to somebody else. To not just hear them saying words but to really think about what those words mean.
'ORLA IS WORRIED BECAUSE SHE WENT FOR AN STI CHECK'
Let’s pick up the Monday morning conversation with Orla. Imagine instead that you decided to actively listen. In this scenario Orla noticed that you were listening closely, and that you were offering her the chance to talk, so she opened up. She mentioned that she had spent most of the weekend worrying and she hadn’t slept well. You have now been presented with second opportunity to practice your active listening. You could say “Oh I know how you’re feeling, I’m really stressed about exams and assignments lately too.” Or you could put aside your own worries and say, “What has you worrying so much?”
Active listening means making the choice to tailor the conversation to the other person, giving them the chance to feel listened to. This means surrendering the reigns of the conversation and following their lead. In this hypothetical situation, you may infer that Orla, like yourself, is stressed out about college. If you start talking about yourself and your own stresses then Orla has to sit back and let you feel heard too. However, it turns out Orla is actually worried because she went for an STI check last Friday and she’s anxiously awaiting the results. If you direct the conversation toward your personal stress, Orla loses the opportunity to open up about what is bothering her. By quieting your own thoughts you give Orla the chance to communicate what she needs to say.
In medicine, poor listening skills can lead to misdiagnosis and poor outcomes. Our listening skills require not only hearing and processing the information patients offer, but evaluating, analysing and problem solving. Taking a thorough history is an integral aspect of determining an accurate diagnosis. This aspect of medical care relies almost entirely on effective communication and active listening. Patients need to feel comfortable with their doctors in order to disclose what are often very personal details. Their comfort level during a consultation is our responsibility and active listening is our greatest asset.
During preclinical years we are often told to convey ‘empathy’. In fact you may have heard this word so often that it has lost all meaning. Here are some practical ways by which we can show our patients that we care:
- BODY LANGUAGE – Be open to a conversation, sit back in your chair, lean against a wall – basically look like you are comfortable or even better actually be comfortable so that you are prepared to have a sensitive conversation.
- SILENCE – Don’t be afraid of it. Everybody feels the need to fill silences, so wouldn’t it be better if the person you’re listening to fills it instead of you?
- PHONE – Put it away if you want to have a real conversation.
- QUESTIONS – Ask questions that follow on from what the person has said to you. This will encourage them to follow their train of thought or elaborate on an idea a little further. This means asking open questions, but it doesn’t mean you have to use vague stock type questions like the ever dreaded “How does that make you feel?” The best way to ask a good question is to actually care about the answer.
Active listening can’t be mastered by applying a few buzzwords and perfecting conversation skills. While these are important, they can only take you so far. You have to actually care about what the person is telling you and really try to understand what it means for them. This act of trying to understand and showing that you are trying to understand is the very essence of empathy. The clinical psychologist Julian Treasure claims that people rarely listen effectively to one another. He describes four steps to listening better: RECEIVE, APPRECIATE, SUMMARISE and ASK. This tool kit can help us to listen actively and convey that we care about what others are saying.
'showing that you are trying to understand is the very essence of empathy'
Reflect for a moment on your day so far. Most of us are experts at receiving information and retorting with socially appropriate responses. We do this without actually appreciating what has been said. The phrase “How are you?” has become something we say in passing rather than a genuine question requiring a response that will be appreciated and acted upon. Have you taken the time to actively listen to anybody today? Active listening is a skill that takes time and practice to perfect, it’s not something that comes naturally to anybody. Let’s start practicing now, in both our personal and professional lives, so that when we meet the patients that need us to actively listen we will be ready.
Give it a go. See what happens.