Active listening

Many doctors and nurses fear that active listening will trap them for minutes hearing information that is unrelated to the disease.  Listening to it, will only distract them. Many health care professionals worry that they do not have the time to listen for stories. But many doctors and nurses who have incorporated listening into their practice more often find that time invested early is recouped quickly.

Indeed, the first few visits with a patient may take more time, but time is saved shortly by having developed a more robust alliance, knowledge and trust from the start.

The serious consequence of not being able to do this kind of listening is that patients’ symptoms get dismissed, their “non medical” concerns get ignored, and treatable disease gets missed.[1]

I would like to give some examples from patients:

Situation: A 23-year-old young man described a skin lesion.
Patient’s statement: “When I look at it, I wonder what it is.”
Diagnostic response: “How long has it been?”
Active listening response: “You are wondering? What kinds of thoughts have crossed your mind?”

Some patients indirectly addressed underlying concerns.

Situation: A 68-year-old non-smoking woman described her cough.
Patient’s statement: ” It’s not that it is that bad but, it’s back. It started to get better with the cough medicine, but now it’s back.”
Diagnostic response: “Have you had any trouble waking up short of breath?”
Active listening response: “The way you describe your cough, I wonder if you have a specific concern?”
Patient’s concern: The patient was concerned about possible lung cancer, because she lost a friend with this disease.

Situation: A 62-year-old man with diabetes.
Patient’s statement: “I’ve found on Google that hypoglycaemia can damage the brain. Is that true?”
Diagnostic Response: The doctor explained the brain’s unique carbohydrate metabolic needs.
Active listening response: “Before I explain, you searched on google, I wonder if you have experiences or concerns about hypoglycaemia?”
Patient’s concern: Having recently experienced an episode of dizziness, and having had several episodes of misplacing his glasses. This patient is worried that he might be developing dementia.

What I’m trying to convey is the kind of listening that will not only register facts and information but will, between the lines of listening, recognize what the teller is revealing about him self.

Health professionals have begun to do research and to write about how they can listen more effectively to their patients. [2]

Dr. K.P. points to a number of barriers physicians face in addressing patients’ emotions. “Physicians are trained to be medically oriented, not psychologically oriented, and patients often express their emotions very indirectly,” she says. “The patient may say ‘the tumor is getting bigger,’ which represents an opportunity for the doctor to acknowledge the emotion that the patient must be feeling. Instead, the medical perspective: ‘Yes, it was 4 millimeters and now it is 6 millimeters.’

Listening to patients’ narratives is critical to effective patient centred care.

[1] R. Charon, Narrative medicine, honoring the stories of illness (2006)

[2] Mack Lipkin jr, Samuel Putnam, Aaron Lazare eds, The Medical Interview and Robert Smith, The Patient’s story

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