June 2001 Bulletin

‘Mindful minute’ sets stage for trust

Uninterrupted time allows physician to mentally lock into the patient

By Sandra Lee Breisch

How can you make your patients feel heard, valued and empowered? "Simply listen wholeheartedly and don’t interrupt them for the first 60 seconds of the visit—and then listen to them some more," says Rebecca Z. Shafir, chief of the department of speech pathology at Lahey Clinic, which provides primary and specialty care at Lahey Clinic Medical Center in Burlington, Mass.

According to Shafir, the first 60 seconds of the visit are critical. "It’s the most powerful step in setting the stage for establishing trust and empowering patients to be a partner in their care," she says. "It’s what I call a ‘mindful minute’ that allows you to mentally lock yourself into the patient, put aside your ego and its agenda to allow the patient to share their health concerns and insights."

Yet, many physicians typically interrupt a patient about 7 to 13 seconds into the visit, notes Shafir. "These interruptions make a patient feel rushed, nervous and not cared for," she says. "If given the opportunity to talk, patients will often provide the physician with information sufficient for making a diagnosis. Patients will also have the time to be more specific about their symptoms and revise inaccurate word choices often used due to nervousness. This uninterrupted time makes the ‘mindful minute’ powerful for both patient and clinician."

Other common listening mistakes include "not allowing silence and letting our minds wander to the past or future," notes Shafir. "These listening mistakes can jeopardize the patient/physician relationship because we all look for the patient to be compliant with their medical care which leads to better outcomes," she says. "Also, when ‘mindful listening’ is present, there is trust. Trust leads to loyalty. We want our patients to repeat their business with us and tell others about us. What physicians do not want are costly and unnecessary hospital admissions and extended stays or malpractice suits related to listening mistakes."

And patients do know when a physician is really listening.

"Patients will pick up cues like eye contact, appropriate responses such as stillness, head nodding, etc. and they will sense a genuine concern," explains Shafir. "But if you mechanically employ these maneuvers and act like you’re listening, patients will quickly sense your insincerity and in many cases they’ll withhold information and never return."

Once a physician "listens mindfully—free of internal distractions," Shafir says, "patients will say things like, ‘I’m not used to doing all the talking,’ or ‘thank you for listening to me.’ And they’ll also complain, ‘I wish other doctors listened to me like you.’"

However, if a patient talks endlessly and a physician needs clarification, Shafir says, "You can say, ‘Excuse me, Mr. Smith, can we get back to….’ You could also ask your patients to jot down anything they felt was not discussed and/or important to their visit. Ask them to hand it to your nurse or physician assistant. Assure them you’ll look it over when you’ve time."

Because Shafir believes that effective listening originates from an "inner state of calm and mindfulness," she suggests physicians use Zen-like meditation techniques or other focussing techniques. "Daily sitting meditation, from 5 to 30 minutes a day is the best way I know to calm the internal distractions that interfere with listening," explains Shafir. "If that sounds like too much of a time commitment start small with a ‘mindful minute.’ Pick a routine task like drinking your orange juice. Hold the glass of juice in your hand for a few seconds and feel the weight and the temperature. Sniff the citrus perfume. Think about the process from orange tree to the juice in your glass. Savor the tart sweetness. Welcome the nutrients.

"Your 60 seconds is up. In that time you were focused in the present, silent, getting the ‘whole message’ that glass of orange juice was sending. Adding more ‘mindful minutes’ to your day will gradually help you become comfortable with silence—the essential ingredient to mindful listening."

A physician can improve his or her own health, too. "Mindfulness and meditation which form the basis of ‘mindful listening’ have been shown to reduce blood pressure rates, even in the face of stress," Shafir says. "As managed care places greater demands on our time and resources, we need to hone the skills that can keep the stress levels to a minimum. Listening is one of them. I can think of a few things that are more stressful than not listening—and one is a malpractice suit. Many malpractice claims are attributed to patient complaints that their physician did not listen to them."

Communicate welcomes suggestions about future topics for the column on patient-physician communications. Send your suggestions to the Bulletin at AAOS, 6300 N. River Rd., Rosemont, Ill. 60018.

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