Contrast listening with the primary intent to respond (reactive listening) to listening with the primary intent to understand
(empathic listening). The word empathy encompasses our capacity to understand and acknowledge our clients' feelings and point
of view, whether we agree with them or not. In addition, empathic listening encompasses our heartfelt desire to understand
the feeling of what is being said in addition to the content of what is being said. It also encompasses sensitivity to nonverbal
elements of our clients' communication. Therefore, the initial phase of the interview with our clients typically involves
asking open-ended questions designed to clarify our understanding of their concerns and also patiently listening attentively
to their responses. This may be categorized as the "client/patient-centered component of the clinical interview." We can convey
our genuine interest by a few words (i.e. "Tell me more", or "Then what happened?"), a nod or a gesture. The goal of empathic
listening is to promote the free flow of information. If interrupting becomes necessary because of lack of understanding,
then we can explain this point with a statement such as, "Excuse me; I didn't completely follow your last comment." As the
interview proceeds, we can exert more influence by making an appropriate transition from open-ended questions to close-ended
questions. Our ultimate objective is to paraphrase or summarize the clients' concerns and point of view in such a way that
they will recognize that we empathically understand them.
Some may object by stating that in a busy clinic or hospital, empathic listening requires too much time, and therefore is
not cost effective. But is this generality valid? It is true that including patient centered empathic listening as a part
of the clinical interview initially might require more time than a tightly controlled doctor centered clinical interview.
However, in the long run, it often is more efficient and requires less time than trying to correct misunderstandings and loss
of our clients' confidence in our character and competence that occur as a result of an imbalance between empathic (patient-centered)
listening and reactive (doctor-centered) listening.
Most of us receive some formal training in speaking in order to learn how to express ourselves to others effectively. We learn
that a fundamental requirement of good speech is that it be easily understood. In context of the practice of veterinary medicine,
this often requires that we communicate with our clients using the language of a non-medical person. While striving to speak
to our clients in a way that fosters understanding, we must use discernment so we don't give the impression that we are talking
down to them. Our conversation should be gracious as well as sensible. Won't you agree that our clients are most likely to
feel our respect for them if we speak in a dignified and caring manner? To paraphrase Hippocrates, our words should first
do no harm. Thought and practice are often required to express the right things in the right way.
In addition, the message conveyed by what we say is often heavily influenced by how we say it. Our comments often impart latent
as well as literal meanings. Messages as simple as "Look who's here!", "Guess who just walked in?", and "What next!" can convey
sarcasm, irony or joy. Why? Because the tone, pitch, volume and modulation of our voice sends powerful signals of what we
are thinking and feeling. Even if you do not understand the language being spoken, if one person sounds impatient, arrogant,
intolerant, critical and harsh and another person sounds humble, patient, kind and compassionate, then it is not difficult
to tell the difference.
Nonverbal factors, such as body position, facial expression and personal appearance, are also key components of communication.
More than any other nonverbal feature, our face often reflects how we really feel. Our eyes, the shape of our mouth, and the
inclination of our head all play a part. Without a word being spoken, our face can convey indifference, disgust, perplexity,
amazement or delight. A face that is devoid of expression can raise questions about our sincerity. On the other hand, a warm
smile tells others that we have a kindly feeling toward them. In addition, a smile can help our clients to relax and to be
more receptive to what we are saying.