Out in the open
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 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 (e.g.,
"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, we can simply say, "Excuse me; I didn't completely follow your last comment."
At the appropriate time, we can exert more influence on the interview by making a transition from open-ended questions to
close-ended questions. The objective is to paraphrase or summarize the clients' concerns 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 valid? It is true that patient-centered empathic listening may take more time initially than
a tightly controlled, doctor-centered clinical interview. In the long run, however, 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 as
a result of an imbalance between empathic (patient-centered) listening and reactive (doctor-centered) listening.
Nonverbal factors such as body position, facial expression and personal appearance are key components of listening. 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
A face devoid of expression may 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 relax and be more responsive in communicating
A wise man once said, "We listen with our eyes." We could add eyebrows to that. Our eyes and eyebrows communicate attitudes
and emotions, including surprise, compassion, fear, grief, doubt or dislike (e.g., He gave her the evil eye.).
Maintaining friendly eye contact with others often promotes trust. On the other hand, our clients may doubt our sincerity
or competence if we avoid respectful eye contact during conversation. Still, discernment is needed. Some may view intense
eye contact as rude, aggressive or challenging.
A matter of trust
In addition to learning how and when to listen, we must want to listen. When clients realize we are empathically listening to them because we want to understand them, they are more likely
to feel we are serving them to the best of our ability. That helps build trusting relationships that enhance our ability to
provide effective patient care.
Stephen Covey, author of The Seven Habits of Highly Effective People, summarized that important concept this way: "Seek first to understand, and then be understood."
By empathically listening to our clients, they in turn are more likely to listen to our interpretations of the causes of their
concerns, and ultimately to comply with our recommendations.
Common barriers to effective listening
Removing barriers is important to being able to listen effectively to our clients. Barriers can come in many forms, including:
Language: Do we attempt to ensure that our clients understand our questions, and do we understand them?
Interruptions: Do we allow cell phones routinely to interrupt us while listening to our clients?
Physical barriers: Is there a desk or an exam table that physically separates us from our clients?
Emotions: We may be uncomfortable dealing with a distraught or irate client. Conversely, a client may be embarrassed by his or her
show of emotion and be unwilling or unable to open the door to communication.
Body posture: Do we stand above our seated clients with folded arms when listening to them?
Time: Are we focused on the clock and not on our patients?
Mental focus: Are we thinking about other problems while giving the impression that we're listening to our clients?