October 2000 Bulletin

Don't just hear; listen to what patient says

By Sandra Lee Breisch

Do you hear, but not listen to your patients? If so, your failure to listen and communicate clearly and effectively might result in your being "off-target" on your diagnosis.

So believes Madelyn Burley-Allen, PhD, an expert in the area of listening and interpersonal communication who has conducted thousands of seminars, authored several books on the topic and is the founder of Dynamics of Human Behavior in Wimberley, Texas.

"Listening is a highly selective and subjective process," explains Burley-Allen. "Effective listening involves being attentive and aware, and the application of listening techniques such as summarizing or repeating what has been said. For effective listening, physicians need to know the difference between focussed and unfocussed listening. Improving communication skills with an emphasis on listening is critical for physicians to effectively diagnose patients’ problems. Otherwise, physicians might be off-target in their diagnosis."

Burley-Allen points to research that shows that the listening efficiency of most people is about 35 percent and it is less when the listener is under stress or is distracted.

She points out that "no two people have exactly the same meaning for a word or expression" because they "filter them through varied beliefs, knowledge, cultural upbringing, education and experience. Meanings are not in words–meanings are in people."

It is "critical" for physicians "to examine" their own listening patterns and "become aware" of the barriers and filters that prevent them from listening properly, she stresses.

"However, since most of us have never had formal listening training in our school systems and rarely in our medical practice environment, it is not unusual for physicians to ineffectively communicate with their patients," points out Jeffrey Tobe, CSP, a consultant for Business Strategies in Pittsburgh, Pa. He conducts creativity workshops for various companies and groups, including the BONES Society.

To help you become an effective listener and communicator, Tobe offers seven communication techniques:

1. Listen with your eyes and your ears. Don’t just listen to the patient, watch their body language, tone of voice and words used.
2. Never interrupt. Once a patient perceives you’re competing with them to speak, the patient may feel uncomfortable in giving you the necessary information–so you won’t be able to relate to them and make an appropriate diagnosis. If you do plan on interrupting a patient while speaking, pause and count to five after the other person stops talking.
3. Ignore distractions. Listen with your eyes, ears and heart. Tell yourself, "I’ll listen to this person only." Do not drift to inner thoughts until the patient is finished speaking.
4. Be an empathetic listener. Give the patient some time to tell how they got their musculoskeletal injury. Rather than just saying, "I am very sorry to hear you have this problem," probe deeper by asking, "What effect has the injury had on your day-to-day functioning?" Encourage the patient to tell you more.
5. Ask open-ended questions such as, "So, how does your injury make you feel?"
6. Model positive behavior by conversing with your patient in a positive way that encourages trust and inspires the patient to open-up.
7. Ask the right questions to avoid ambiguity. If your intuition tells you that the other person really means something other than what he or she is saying, restate what you believe their message is to prove or disprove your assumption.