Lessons on listening

Lessons on listening

Techniques to improve your skill as diagnostician, compassionate doctor and manager
May 01, 2008

"For everything there is an appointed time. ... A time to listen and a time to speak."

— Ecclesiastes 3:1-8

Most would agree that there is an art as well as science to the practice of veterinary medicine, and that communication is a vital component of providing highly effective patient care.

Whether one thinks of communication as an art, science or both, one fact is certain — we could not practice veterinary medicine without communicating with others. How we communicate with our clients can be a source of mutual understanding and positive action or a source of misunderstanding and frustration.

Which of these communication components is, in your opinion, most important: listening, speaking or understanding?

This month we consider the importance of listening. Speaking and understanding are topics for future columns.

Learning to listen

Effective communication involves more than mastering speech. It is vitally linked to our desire and ability to listen. Although many of us have had formal training in reading, writing and speech, how many of us have been trained to listen effectively?

Listening is a skill most of us acquire informally. Our lack of formal training in listening is ironical, considering that successful communication with our clients depends on listening and understanding their needs and feelings. In fact, the first step in collecting diagnostic information typically begins with listening to our clients' concerns.

Good listening skills are not only essential for accurate evaluation of a patient's illness, but empathic listening conveys our interest in the overall welfare of the client and patient. Therefore, in addition to developing our IQs, we must learn to develop our EAR-Qs.

An ear toward reactive listening

When we to listen to our clients, what should be our primary motive? Should we listen mostly with the intent to reply? If so, we are practicing reactive listening.

When we listen reactively, often we provide responses that convey our point of view about clients' concerns. This may be categorized as the "doctor-centered component of the clinical interview." Some may ask, "But, isn't this our primary goal? Isn't it true that if clients are seeking our expert advice, they should be listening for our recommendations?"

Have you ever visited a physician who didn't take time to carefully listen to your concerns before making a diagnosis and recommending therapy? Have you encountered doctors whose controlling style of inquiry about your concerns felt more like an interrogation than a conversation? If you have, you are not alone.

In one study, physicians interrupted 69 percent of their patients before they could complete their opening statements. The average time-lapse to the first interruption was 18 seconds. Once interrupted, fewer than 2 percent of patients went on to complete their statements (Beckman et al: Annals Internal Medicine, 1984, 101: 692-695).

If the doctor responded to your concerns without really understanding them, how did you feel? Did you have confidence in his recommendations? Would you return to him/her again?

Now, compare this feeling to the response you had when a physician took the time to listen to you with the intent of understanding your concerns. What is the point? Failure to listen with the intent to understand clients' feelings and viewpoints can be a major obstacle to further communication. In this situation, many clients may lose confidence in our desire to help them. Many won't care about how much we know until they know how much we care. To some, caring is more important than curing.

Contrast reactive listening (with the primary intent to respond) to empathic listening (with the primary intent to understand). In the context of this essay, 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 desire to understand the feeling of what is being said in addition to the content. It encompasses sensitivity to nonverbal elements of our clients' communication.