The Art and Skill of Listening

6231641551_541c96e583_bBlog post by Bernadette Keefe MD

Listening to the world around us, its people and nature, educates us about our world and allows for meaningful conversation. Without the ability to listen, we are unable to sustain relationships and learn. Likewise we place ourselves out of range of others: unable to provide help, to answer needs. For many reasons, we must acquire the skill of honed, effective listening.

Most of us know this, but human nature has a stronger impulse to share, speak first, get our idea out right away. Even when we need to hear the other person and indeed want to listen to them, we have very strong impulse to interrupt, to jump in. Such impulses can crowd out the other personsʼ opinions and thoughts, whereby they may never be heard.

Listening in Healthcare

The subject of listening (or not) has been getting a public airing in discussions regarding doctor/patient communications.

The New York Times just ran an opinion piece by Nirmal Joshi MD, Chief Medical Officer of Pinnacle Health System titled “Doctor, Shut Up and Listen”. While I donʼt use nor like the term “shut up”, the message of his piece was excellent. Several salient quotes include:

A doctorʼs ability to explain, listen and empathize has a profound impact on a patientʼs care. Yet, as one survey found, two out of every three patients are discharged from the hospital without even knowing their diagnosis.another study discovered that in over 60 percent of cases, patients misunderstood directions after a visit to their doctorʼs office And on average, physicians wait just 18 seconds before interrupting patientsʼ narratives of their symptoms.

…we need to move away from the perception that social skills and better
communication are a kind of optional extra for doctors.A good bedside manner is simply
good medicine.

The Guardian newspaper published an opinion piece by James Munro discussing the importance of listening to people. A poll taken after the Francis inquiry on failings of the NHS asked people what NHS hospitals most needed to improve. The most frequent response was “listening to patients and carers about how services should be improved”.

Although that request was received, it was not truly understood. To paraphrase from the article: One senior NHS leader claimed that a data rich health service is a listening health service, but I would be willing to bet that when they said please listen, the public didnʼt mean “please give us another survey to complete”.

Understanding context and audience in healthcare

A key issue with respect to listening in the healthcare space is not understanding the context and circumstances of oneʼs audience (the patient). A very nice piece by Lisa Suennen, “Health Literacy in a Consumer Centric Healthcare System” addresses the wide gap in communication between healthcare professionals and many patients (and how it might be closed). It is notable that while education helps with health literacy, even very educated persons have trouble with the jargon of healthcare professionals and the healthcare insurance industry. The videos included in the article are illustrative.

Another article on this topic, “Active Listening in Cross Cultural Communications” addresses the three essential components of ʻActive Listeningʼ: preparation, mindful non- verbal communication and reflection. Quoting from the article:

Preparation reduces stress and allows you to be fully present for the patient encounter. Mindful non-verbal communication entails intentional use of your attention and nonverbal body language to encourage the patient to be open. Reflection helps to clarify points that may be vague or non-specific and communicates your desire to know the patientʼs story.

Honing the skill of listening

Indeed, we all recognize our need to listen better and with more focus. I daresay all aspects of our lives would benefit from a little more listening and a little less talking, less multitasking. Thankfully there are plenty of resources available to help us hone our listening skills. I will highlight of few of them below.

TEDTalk Global 2011 by Julian Treasure : “5 Ways to listen better”.

Paraphrasing a few excerpts:

  • We are loosing our listening (ability). We spend 60% of our communication time listening but retain only 25% of the information. What is listening? It”s making meaning from sound extraction.There are a number of tools and filters our mind uses. One is recognizing patterns to distinguish signal (the info) from noise (irrelevant background). The others are more personal,the (often unconscious) filters we bring to conversation:culture, language,values,beliefs,attitudes,expectations and intentions.
  • Some causes for loosing our ability to listen include the advent of multiple ways of recording information (writing, audio, video) which mean less of an imperative to listen intently the first time and the “noise” escalation in our world. We have a cacophony of sounds to decipher throughout the day, and thus simply tire and lose our focus.
  • Much of conversation has become broadcasting. The decibel levels have increased, the intensity and amplitude of conversations becoming deafening. We retreat to headphones and then no one is listening.

Julian Treasureʼs: 5 tools to better listening

  1. Quiet: three minutes a day of silence (quiet)
  2. The mixer: select channels to listen to amidst multitude of sounds (ie coffee
    house,party or in nature)
  3. Savoring: listen to mundane sounds, the hidden choir ( ie washing machine etc)
  4. Change listening postures: active/passive, reductive/expansive, critical/empathic
  5. R A S A: Receive (pay attention), Appreciate (small sounds acknowledgement), Summarize, Ask questions

Julian Treasure ends his TED Talk with pleas for better listening from each one of us, and listening,as a skill, be taught in schools.

Listening is our access to understanding. Conscious listening is how we get to mutual understanding, how we get to a world of connection, a world of understanding and a world of peace.

Further stories about listening:

TEDTalk by Tony Salvador (Intel Co) “The listening bias”.He emphasizes that to be a good listener we have to be willing to be vulnerable. He stresses we must listen as if its the first time we have heard anything about the particular subject (or as if its the first time we have met the person with whom we are speaking).

Yet another intriguing TED talk is Ethan Zuckermanʼs “Listening to global voices”. He shows how segregated (nations/politics/race/etc) are conversations are on twitter and stresses that we are greatly missing out by not connecting to wider world.

We can learn about listening from the world of marketing. The article “How Social Listening Can Improve Your Marketing” stresses that listening is a two way street, that response is part of the bargain. A message received is a message acted upon.

Finally, a quote from J. Krishnamurti from “An Art of Listening”:

There is an art of listening. To be able really to listen, one should abandon or put aside all prejudices, preformulations and daily activities. When you are in a receptive state of mind, things can be easily understood; you are listening when your real attention is given to something.

Join us Tuesday January 13th at 8:30pm Eastern (for your local time click here) for the weekly #hcldr tweetchat where we will be discussing the following questions:

  • T1 What sorts of listening problems have you encountered in your healthcare system?
  • T2 At what age should children formally learn to listen, and how?
  • T3 Is our use of social media affecting (helping/hurting) our ability to listen?
  • T4 What are strategies you might employ to improve your listening?

Resources

“Doctor, Shut Up and Listen”, Nirmal Joshi, New York Times, January 4 2015, http://www.nytimes.com/2015/01/05/opinion/doctor-shut-up-and-listen.html?_r=0, accessed January 9 2015

“How the NHS should listen and act on patient complaints”, James Munro, The Guardian, November 5 2014, http://www.theguardian.com/healthcare-network/2014/nov/05/nhs-listen-act-patient-complaints, accessed January 9 2015

“Health Literacy in a Consumer-Centric Healthcare System: A Case for Mickey Mouse”, Lisa Suennen, January 4 2015, http://venturevalkyrie.com/health-literacy-in-a-consumer-centric-healthcare-system-a-case-for-mickey-mouse/, accessed January 9 2015

“Active Listening in Cross-Cultural Communications”, Medscape, 2008, http://www.medscape.com/viewarticle/706908, accessed January 9 2015

“5 Ways to Listen Better”, Julian Treasure, Ted Talk, July 2011, http://www.ted.com/talks/julian_treasure_5_ways_to_listen_better?language=en (video), http://www.ted.com/talks/julian_treasure_5_ways_to_listen_better/transcript?language=en (transcript),  accessed January 9 2015

“The listening bias”, Tony Salvador, Ted Talk, http://www.ted.com/watch/ted-institute/ted-intel/tony-salvador-the-listening-bias, accessed January 9 2015

“Listening to global voices”, Ethan Zuckerman, Ted Talk, July 2010, http://www.ted.com/talks/ethan_zuckerman, accessed January 9 2015

“The Voice of Twitter Users”, Evan Williams, Ted Talk, February 2009 http://www.ted.com/talks/evan_williams_on_listening_to_twitter_users?language=en (Video and transcript), accessed January 9 2015

“Listening and Focusing: Holistic Health Care Tools for Nurses”, Joan Klagsbrun, 2012, http://www.focusing.org/klagsbrun.html, accessed January 9 2015

“Listening”, http://en.wikipedia.org/wiki/Listening, accessed January 9 2015

“Hearing”, http://en.wikipedia.org/wiki/Hearing, accessed January 9 2015

“Praying for Time to Listen Without Prejudice”, George Michael (song), https://www.youtube.com/watch?v=dGZ0qhkOC5o, accessed January 9 2015

“There’s a Doctor/Go to the Mirror!”, The Who (song), Amsterdam 1969, https://www.youtube.com/watch?v=3AmlmxnpGq4, accessed January 9 2015

Image Credit

Listen, Understand, Act – Steven Shorrock

https://www.flickr.com/photos/highersights/6231641551/in/photolist-auEMVH-a5RSzb-bfaqtD-359VMi-dhLQUx-4KjwBG-7E3cdY-3iEeZ2-4tVpTu-cxedwN-5WduhB-7yXPYm-4waFtM-6YfNGb-4pfa8u-59M7KG-63zEPR-67nNta-fUCwSF-98HKz-fDYjT8-9DZ7ZJ-8fYbgf-5LTdXV-axtohs-pKPanJ-dXvjpm-6HNhXr-mNpaTt-82yGBo-fsA5BG-8jUGmf-4pmR5A-aBYyUH-nUJarw-7hqMSQ-5SZmMP-aFuQtT-4iTsX2-uHG13-8xqVHk-BswmU-bjxDk1-8dYT8V-p6xf7g-atRJ9b-5SLqSv-ojjNab-3G34h-cGmixL

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5 comments

  1. Reblogged this on HealthcareVistas – by Joseph Babaian and commented:
    A great discussion on the ability to understand before being understood. A not to be missed #hcldr this Tue 830p E – see you there!

  2. For a caregiver’s perspective of the necessity of “listening” during physician-patient encounters, I would submit the follow post from the blog Mind the Gap – Listen To Your Patient And They Will Tell You The Problem – A True Story. http://wp.me/p4tfbo-1z0

  3. […] Find original post by me on: HCDLR […]

  4. […] have been useful for breaking down silos and bridging ‘tribes’. Two have focused on listening (here and here), one on questioning (here), and two on the human condition (here and […]

  5. […] have been useful for breaking down silos and bridging ‘tribes’. Two have focused on listening (here and here), one on questioning (here), and two on the human condition (here and […]

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