09 Oct A Different Approach to Listening: Building Valued Connections in Healthcare
“A Different Approach to Listening: Building Valued Connections in Healthcare” — By Dr. Read Pierce, MD — VP of Strategy and Culture Transformation at the Institute for Healthcare Excellence
Have you ever tried to have an important conversation, and felt like the other person didn’t really listen to your concerns? In an era when communication is more ubiquitous, faster, and—seemingly—easier than ever before in human history, it’s striking that quite often, people leave a conversation (whether in person, by phone, or digital) feeling like they didn’t really connect or, worse, were substantially misunderstood.
In healthcare, this paradox matters. Not only are the stakes higher—we often and quite literally are dealing with people’s lives and wellbeing—but we also carry a belief that the human experience of health and illness is an integral part of the conversation and relationship between patients, families, and their care teams. Put another way, we believe that what makes doctors and nurses different from technicians and AI algorithms, which may soon be able to offer accurate answers and prescribe treatments to a wide range of health conditions, is that the humans giving care possess empathy, and can use it for emotional connection that is inherently valuable, above and beyond getting the right technical answer to a person’s disease state or treatment plan. Given this collective belief, it’s no surprise that people go into medicine to care for others, not simply fix others’ problems.
Why Listening Is So Important:
To achieve that type of connection between people, feeling heard and respected is critical. Indeed, in national surveys, these attributes of caring rank above clinical competence for the majority of patients in the United States (Wen LS, Tucker S. “What Do People Want From Their Health Care? A Qualitative Study” J Participat Med. 2015 Jun 18; 7:e10.). And yet, roughly a third of the time, patients leave a conversation with their primary care physician or specialty physician feeling that they didn’t get to talk about their chief concern (“National Results from the 2014 Inpatient Survey.” National Results from the 2014 Inpatient Survey (2015): 1-54. Quality Care Commission, May 2015. Web. 19 June 2017.)
If doctors and nurses went into medicine to take care of people, and people seek human connection with their clinicians, how is it that we miss the mark on human connection a third of the time?
The Barriers to Really Listening:
Clinicians cite several reasons for struggling with listening, including time, efficiency, and a focus on data collection requirements. Time constraints are a reality in modern medicine, and thus many in healthcare are concerned that the listening exchange will take too long, veer off topic, and include tangential stories by patients—all activities that get in the way of capturing mandatory data for quality reporting, ensuring screening checklists are complete, and finishing required electronic documentation in a timely manner. In addition, doctors may be reluctant to let patients lead the conversation, because they feel a professional obligation to guide the discussion to what is perceived to be most important during a visit, based on years of clinical training. Moreover, patients and families may not speak up during their visits, due to a general mistrust of the healthcare system, concerns about stigma and bias, or their own emotions (fear, anxiety, confusion, frustration).
What Happens When We Don’t Listen?
While spending less time talking and listening seems to offer short term efficiency, failing to listen well results in multiple negative side effects in clinical medicine. Trust tends to erode when listening is poor, and with less trust comes a tendency among patients to withhold important information from the clinical team. At the extreme, this may result in missing the diagnosis, requiring multiple visits or second opinions to get to the root of what is happening in a patient’s health. Even if the first diagnosis is correct, evidence suggests patients who do not feel heard are less likely to follow the recommended treatment plan, which leads to considerable wasted effort by clinicians and missed opportunities for better health among patients.
What Does it Take to Listen?
When another person is truly listening and paying attention, we can detect it in their body language, eye contact, facial expressions, and statements of connection. However, these statements of connection—whether they are questions, affirmations that the listener had a similar experience once, or other spoken phrases—are interruptions, even when we intend to demonstrate that we are listening to the other person. Despite the best of intentions, the listener who interrupts changes the course of the speaker’s story, either prolonging the time needed to reach the primary point or completely derailing the storyteller, in which case the listener never hears the punchline.
Reflective listening is an alternate approach that allows us to pay close attention to the other person, not our own thoughts, agenda, or tasks. It involves resisting the urge to interrupt until the other person finishes while expressing sincerity and connection through non-verbal cues alone. When the other person finishes, before asking questions, making comments, or directing the conversation toward a particular goal, the listener then summarizes what the speaker said using words and phrases the speaker employed. In clinical medicine, using phrases like “So I hear your saying . . . ”, “You seem to believe that . . .”, or “You’re concerned about . . .” signals that the clinician was paying close attention and quickly clarifies and confirms the key message that a patient or family member hopes to convey.
Reflective listening is powerful, because it makes transparent things that often go unspoken. First, the listener illustrates that she was present and attentive for the speaker’s entire story. Second, the listener validates that she received the key elements, offering both people a chance to clarify any misunderstandings immediately. Third, the listener demonstrates a commitment to respect, by allowing the speaker to direct his or her story to its logical conclusion, rather than bending it to the listener’s interests by interrupting or asking questions. Practicing reflective listening is an efficient and simple way to amplify positive emotions in human connection, such as curiosity in the listener and validation in the speaker, which often go missing when communication occurs solely for the purposes of information exchange. Indeed, some researchers consider feeling heard very similar to being loved. Furthermore, listening well heightens trust, increasing the likelihood that the speaker will raise delicate issues that may be vital to making the right diagnosis or crafting an accurate treatment plan.
Refining our listening skills in healthcare is well worth the effort because we see the benefits immediately: stronger human connections, more visible empathy, increased trust, and better, more efficient care. In other words, listening is one of the key ingredients to the kind of healing patients seek and clinicians aspire to deliver—something that makes the work of healthcare truly human.