Listening isn’t a passive activity. It takes skill and practice, but can result in improved patient care.
Fam Pract Manag. 2005 Apr;12(4):68.
Listening is an important skill for family physicians. It can help improve your diagnosis of patients’ problems, it can help you understand the psychosocial issues affecting their health, and it may even help you avoid a lawsuit.1 However, listening is a learned behavior. It is not a passive activity but one that requires skill and practice. Here are five ways to improve your listening during face-to-face patient encounters.
1. Concentrate on the person speaking. Be sure that you are close enough to – and looking at – the patient to observe his or her facial expressions. Facial expressions, gestures and posture all convey the patient’s thoughts, so pay attention to them. Remember that most communication is nonverbal.2
In addition, make eye contact. Without staring, look at the person long enough to notice the color of his or her eyes. Even when it’s your turn to speak, you can continue to listen with your eyes. If you realize by the patient’s facial expression that you have said something incorrect or worrisome, correct yourself or ask the patient about his or her reaction.
2. Avoid trying to think of an answer. It has been estimated that physicians interrupt patients within 23 seconds as they try to explain their problems.3 Be conscious of this. When a patient is speaking, focus on what he or she is saying rather than on what you are going to say next. Even if you disagree with the patient, try to keep an open mind and allow the patient to finish his or her thoughts before you jump in.
3. Eliminate distractions. Time constraints and pressures are often unavoidable, but they should not compromise your care. When a patient is speaking, do not read a chart or accept a telephone call. If your staff is dedicated, enlist their help in limiting such distractions during face-to-face encounters. For example, if the chart and exam room are well organized before you enter, you won’t have to search for information or supplies when you should be listening to the patient.
4. Be respectful. You and your patient have the same objective: to find a solution to the patient’s problem. You are not on opposing sides, with the other party at fault. Without judging, listen to identify the patient’s agenda or imminent need. It is possible that this person believes no one cares about him or her, so listen with a sense of caring. (The best way to do this is to really care.) Develop a friendly rapport with the patient and validate his or her concerns, as this will help the patient to be more open and trusting.
5. Pay attention to vocal inflections. The tone of a person’s voice can often tell you more than his or her words. It may suggest that the person struggles with anger or depression, or it may point to a physical problem.
In some cases, you may need to get past the person’s tone of voice in order to listen effectively. For example, based on the tone of voice, you may be tempted to dismiss a patient as a complainer. Before you do that, listen and make sure there are no legitimate issues you need to address.
As a medical student, you learned anatomy. As a resident, you learned how to diagnose problems. Now, as a physician, you can learn to listen better.
Listening will help you engage fully with your patients, make better decisions and ultimately provide better patient care.
Dr. Brittin is an adjunct faculty member at the University of Washington at Tacoma, where she teaches “Communication in the Workplace.”
Conflicts of interest: none reported.
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1. Lester GW, Smith SG. Listening and talking to patients. A remedy for malpractice suits? West J Med. 1993;158(3):268–272.
2. Asher M. Body Language. London: Carlton Books Limited; 1999.
3. Marvel MK, Epstein RM, Flowers K, Beckman HB. Soliciting the patient’s agenda: Have we improved? JAMA. 1999;281:283–287.
Copyright © 2005 by the American Academy of Family Physicians.
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