When it comes to open doctor-patient communication, it isn't just about speaking and writing. One of the most important elements of communication is active listening. Active listening, as the name suggests, is listening actively. It is the most effective and the highest level of listening. Active listening entails listening with all senses and paying attention to the individual speaking – the patient. However, active listening is more than just hearing what it said. It is also about being ‘seen’ to be interested in what the patient has to say and not interrupting them in the process. Interest can be shown in two ways – by using both verbal and nonverbal techniques. Verbal techniques include backchanneling (saying things such as ‘mhm’ or ‘I see’), showing empathy through expression, repeating what the patient has said, and asking relevant questions. Nonverbal techniques include maintaining eye contact, smiling, using gestures, and nodding with your head in agreeance. By providing this type of feedback, the patient will likely feel more comfortable in their surroundings and thereby feel more at ease to communicate with you openly and honestly.
You may have heard of the 55/38/7 percentage that relates to proper communication and states that 55% of communication is body language, 38% is tone, and 7% is words spoken. Being an active listener means staying focused and paying attention to these three aspects - body language, tone, and words spoken. According to Dianne Schilling, the 10 steps to being an effective active listener include the following:
- Face the individual speaking and make eye contact;
- Be focused, but relaxed;
- Listen to the words spoken by the individual speaking and attempt to picture what he or she is saying;
- Pay attention to nonverbal communication – what is not being said;
- Strive to feel what the individual speaking is feeling;
- Keep an open mind;
- Do not interrupt the individual speaking and impose your own solutions;
- Ask questions to ensure your own understanding;
- Wait until the individual speaking has paused in order to ask clarifying questions;
- Provide the individual speaking with feedback;
“We need to understand the major distinction between listening and hearing. I like to use the following example to illustrate this: Imagine an occupied house at night, with all of the family home. The parents are fast asleep, with the usual night noises filling the room, the hum of the air conditioner, the snoring, a tap dripping, when suddenly, the mother wakes up and rushes to the next room where the children are asleep, because she heard her daughter cry out. How could she hear the cry of her child while still asleep and over all the other auditory input coming into her ear? The answer is simple: It is because she cares and hence, is able to differentiate between all the other sounds and the one that matters to her. This is the distinction between hearing and listening,” wrote Dr. Shenoy Robinson, author of Dr. Shenoy’s Blog.
As individuals, we all want to be seen and heard. However, as a healthcare professional, active listening is a priority in the medical field and here’s why:
- You earn patients’ trust and respect – Clinical settings tend to be fueled by time pressures and stress, sometimes both for you and your patients. Needless to say, your patients will appreciate your understanding and constant support. By knowing and acknowledging patients’ personal or medical issues, you make them feel valued and respected. It is the trusting and respected patients that are most likely to remain loyal patients.
- You understand patients’ thoughts and concerns and you can create optimal solutions – It is no surprise that the clinical setting can be a scary place for some of your patients. A patient may fear receiving unfortunate news about a medical diagnosis or they may fear your use of invasive, diagnostic tools. When you are actively listening to patients’ thoughts and concerns on certain subjects, you gain a better understanding of how to respond and create optimal solutions that best reflect your professional ability and their unique needs. For instance, consider taking notes during patient appointments. This way, you can provide valuable feedback and ask necessary follow-up questions after the appointment has ended.
- You can reduce conflict in the workplace – In every workplace, there are times when conflict is inevitable. You may come across patients who are feeling frustrated or staff members who are feeling overwhelmed. At times, even though you may not agree with patients’ or your staff members’ opinions, it is important to be open to their viewpoints through actively listening. Conflict tends to make individuals defensive and if an individual feels they are being listened to and they are taken seriously, a resolution can be made much quicker. Moreover, if both parties feel they are being listened to and their concerns are addressed, the resolution is likely to be long-lasting.
Today, a shift has been made from the traditional medicine-centered approach to a more patient-centered approach. With this change, an emphasis has been made more on patient experience and patient satisfaction. Part of addressing this change is being able to communicate effectively in order to deliver better outcomes. Not only is communication an essential part of the patient-centered approach, it can present severe consequences if it is not exercised. In fact, research shows that:
- 25% of patient malpractice lawsuits were brought about due to poor delivery of health information;
- More than 70% of patient malpractice lawsuits were brought about due to poor doctor-patient relationships;
- Sensitive patients viewed their doctors as being uninterested and uncaring;
Malpractice lawsuits are led by poor communication, decreased patient satisfaction, bad patient experiences, and even breach in doctor patient confidentiality. The problem with such consequences, nowadays, is the fact that patients’ experiences can be posted on social media instantaneously. If a patient is not satisfied with your knowledge and expertise, they can rant about you on a Google review just as soon as they walk out your door. Once they do that, the post can be seen by anyone, including your current and prospective patients. This is where active listening comes in. You may have noticed that some of your patients are better at communicating than others. However, this does not mean that they do not want to be heard and this should not diminish your willingness to engage in active listening. If patients feel that they are being listened to and they can rely on you for proper diagnosis and treatment, you can build solid doctor-patient relationships. Solid relationships enhance patient experiences and increase patient satisfaction, thus likely leading patients to make referrals about your practice to their family and friends. What’s more, active listening increases your chances of delivering better patient outcomes.
“The art of listening is crucial for achieving optimal patient care and can also be therapeutic. I would like to apologize to my patients for all the times I did not engage in active listening. Henceforth, I promise to be the physician who listens and incorporates her patients’ thought process into her treatment plan rather than just declaring diagnoses and offering advice. I also urge other physicians to enlist in the same approach despite time constraints. Active listening should be a physician’s priority as it can alleviate burden and mitigate concerns,” wrote Neha Sharma, hospitalist.
What all speakers or more specifically all patients, are looking for, is empathy and respect. They want to know that their words are acknowledged, understood, and addressed. As a healthcare professional, patients’ thought processes should be included in their treatment plans. Many doctors get hung up in the quantity and forget about quality. Treatment should never be a one-size fits all solution, but rather should be unique to your patients’ preferences and needs. If you approach each patient interaction by actively listening and showing a proper dose of empathy, you will surely increase open and honest communication between you and your patients.
- Active listening involves both verbal and nonverbal cues.
- More sensitive patients need to be dealt with differently, by paying more attention to their body language.
- Listening actively is crucial to optimal patient care.