Blog post by Joe Babaian
Seek First to Understand, Then to be Understood – Steven Covey
Is your doctor really present during your visit? – Suzanne Koven M.D.
The topic of Authentic Listening has become even more important as we accelerate into healthcare innovation and system redesign. We have not yet moved the needle toward true meaningful engagement that begins with active listening. Learning to listen without just working on our responses goes against the high-speed world we are all part of. We feel that engaging means we have to have a useful, intelligent, and fast answer ready to go when we get an opportunity to speak. I argue that the value we seek is in deep listening and understanding well before compiling a response.
The clinician turns away from the screen to listen to her patient versus typing and making motions that make it appear like the messages are being received. The leader takes a moment to think about the feedback from a recent meeting – did I listen and internalize the comments, or was I just giving the impression of listening so that I could move along?
Dear friend and #hcldr peer Larry Gioia has spent a lot of time discussing the act of true listening and #heartspeak as a way to convey authentic meaning:
We’ve all been there. At the bank, the grocery store, the mall, the clinic, and the hospital: We spend a few minutes explaining what we want and we get the blank-looked reply and a response ranging from “huh?” to some words that don’t begin to address the request. It’s understood that everyone is pressed for time and every organization faces financial pressure, yet we haven’t found a way to assure clear understanding from the most important communications – those in healthcare.
I personally experienced a case of not being heard. At a clinic visit for a sore throat of unknown etiology, my nurse offered different swabs as part of her triage. Since I had no idea what caused my sore throat and I had said as much, how could I accept or even have a basis to decide? It felt like healthcare by menu. Fortunately, the provider (Their term. I like terms like Nurse Practitioner or, egads, Doctor) heard me and immediately took a look:
Some have suggested that a primary-care (or otherwise) clinician shortage is one cause for this rushing and failure to authentically listen and slow down, A comment from Sherry Reynolds stands out:
Dave Chase replied to Sherry with a telling comment:
A complex and important question to be sure. The very pressures of the real, imagined, or created doctor shortage finds its roots in financial pressure and the “shortage” manifests itself in difficulty getting an appointment and when you do get one, you often face the communication gap.
No one expects 45 minutes to chit-chit with your PCP about the weather, but if you do have 15 or 20 minutes, you should expect authentic conversation. In fact, the disservice of one-way communication is to both the clinician and the patient. The patient needs/issues/changes are often not understood, leaving the patient at risk. Further, the clinician finds themselves at risk of not providing care but just being there but not present.
Suzanne Koven M.D. talks about this in her telling article, “Is your doctor really present during your visit?” when she notes:
Am I “present” in my practice, even when I am in?
She considers the 1984 study that found physicians interrupting patients within 18 seconds on average and sees little improvement over 20 years later in “Tell the Doctor All Your Problems, but Keep It to Less Than a Minute” when it comes to understanding via authentic communication:
50 percent [patients] leave their doctors’ offices uncertain of what they are supposed to do to take care of themselves.
Increasingly, more and more physician time gets taken up with the iPatient, leaving the real patient in the bed feeling neglected. And the bizarre way health care is funded and the way incentives are lined up in this country (we are paid to do to people, rather than for people — sticking a needle in or performing a test pays more than listening), we are pushed to spend more time with the “iPatient” (much of it spent documenting the time we supposedly have spent with the live patient).
Certainly, we all recognize this paradigm and face the looming obstacle of shifting to a new track, getting something done, and re-engaging authentic communication that allows care to truly begin with each patient interaction. After all, aren’t the people the reason healthcare exists?
Let’s consider where we’ve been, where we are, where we need to be as well as the implications along with the #hcldr community of professionals, patients, clinicians, administrators, lurkers, counselors, social workers, designers, and advocates! Please join us on Tuesday April 9, 2019 at 8:30pm Eastern (for your local time click here) as we discuss the following topics:
- T1 How critical is the need for authentic listening in healthcare and why? Is this related to the “doctor shortage?”
- T2 Do you agree with Dr. Verghese’s characterization of the healthcare treating “iPatients” vs. “real” patients?
- T3 What experiences do you have with poor (or no) communication in healthcare? Did you find a way to overcome?
- T4 What can we do to #shift the model and create the real connections that enable highest-quality care once more?
“Doctors, listen to your patients” Abraham Verghese, CNN, Oct 02, 2011. http://www.cnn.com/2011/10/02/opinion/verghese-doctors-touch, accessed April 1, 2019
“The Effect of Physician Behavior on the Collection of Data” HOWARD B. BECKMAN, M.D. and RICHARD M. FRANKEL, Ph.D., Annals of Internal Medicine , Nov 1, 1984. http://annals.org/article.aspx?articleid=699136, accessed April 1, 2019
“Is your doctor really present during your visit?” Suzanne Koven M.D., KevinMD, Aug 5, 2013. http://www.kevinmd.com/blog/2013/08/doctor-present-visit.html, accessed April 1, 2019
“Lack of Listening is the Core Problem in American Health Care” Stephen C Schimpff, MD, Medical Megatrends and the Future of Medicine, April 14, 2014. http://medicalmegatrends.blogspot.com/2014/04/lack-of-listening-is-core-problem-in.html, accessed April 1, 2019
“Tell the Doctor All Your Problems, but Keep It to Less Than a Minute” Meredith Levine, New York Times, June 1, 2004. http://www.nytimes.com/2004/06/01/health/tell-the-doctor-all-your-problems-but-keep-it-to-less-than-a-minute.html?pagewanted=all&src=pm, accessed April 2, 2019
“A Study of Patient Clues and Physician Responses in Primary Care and Surgical Settings” Wendy Levinson, MD; Rita Gorawara-Bhat, PhD; Jennifer Lamb, BS, JAMA, Aug 23, 2000. http://jama.jamanetwork.com/article.aspx?articleid=193022, accessed April 5, 2019
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