The current cultural ethos asks us to “engage and to add your voice to the conversation.” Mostly, that seems to translate to shouting into the wind, and then when we do not get an answer, to shout more loudly. Perhaps the problem we face is not a burning need for more voices or for louder words, but for more listening. The ability to listen seems to be a little less celebrated. We can all recall a time when we thought, “That person talks too much.” How many times do we think, “That person listens too much?”
When I see a new patient in the office, I often ask what was not working before they saw me– what the last doctor they were seeing was not doing. The most common answer is “They didn’t listen.” While this does not seem too surprising to anyone that has a frequent interaction with healthcare in America, the fact that it is not surprising is, in itself, also worth paying attention to. Listening has become rare.
I can often arrive at a likely diagnosis pretty quickly into someone’s story. But making a diagnosis is only a part of what is important. My work also includes building relationships with people– a diagnosis happens in the context of a relationship. There is no shortcut to building a relationship. In order to actually help the people that see me, I need to understand more than just the cough or fever or pain. I have to understand the person.
Listening is sometimes conflated with information gathering. We mistakenly believe that the acquisition of data is the same thing as the process of building a connection with another person. But having more information about someone is not synonymous with having a relationship. If curiosity is the basis of love, listening is the road on which curiosity travels. It is difficult to form a connection with someone without actually knowing them, and it is difficult to know someone without listening to their story.
In most practices, a standard patient appointment is 10-15 minutes. A new patient appointment is about 30 minutes. When I first started working in this model of care, I gave myself an hour to get through the first appointment. Having been in a model now where I spend more time with people, I’ve noticed that I listen better– I am listening not just for a diagnosis, but to understand the person. It is a fundamentally different way of approaching care. It is not, from a modern perspective, particularly efficient. It is, however, much more healing. Strong relationships are not just needed in medicine– we need strong relationships with our friends, our partners, and in our communities. But how do we listen better?
I’d suggest starting with two simple suggestions: first, take the time. Second, pay attention. Look at the person you are listening to, and focus on what they are saying, not on the things going on around you. As we listen, the goal is not to prepare a rebuttal or let our thoughts wander, but to just tune into what the other person is saying– both with words, but also the tone and body language.
Our own assumptions and beliefs will distort what we hear, and it takes effort to keep that from getting in the way. Our role is to understand (even if we do not agree). The goal is to set down, at least temporarily, our objections. It is quite difficult to hear someone say things that are utter nonsense and keep our mouths closed (at least, I think so!). Our human instinct is to jump in, to correct, to set them straight. Don’t give in to that temptation.
Asking clarifying questions, and summarizing main points to ensure understanding are helpful strategies. These questions are not interruptions– they come in after the thought has been completed, and importantly, are not a counter argument, but a point of clarification. Think of active engagement and understanding.
Active listening is not a commitment to agreement, but interestingly, if our goal is to change someone’s view, we are more likely to accomplish that goal after we have heard what they have to say. Ironically, if we really want to convince someone of our own point of view, doing so starts with understanding, with listening.
A final thought. It is pretty easy to feel discouraged by the state of the world today, by the lack of human connection and the difficulty at building community. I often talk with people about the imperative to form relationships with other people, and to deepen the relationships we already have. Here is a concrete action that you can take right now to make your little corner of the world a better place.
Listen.
Doc