How are your listening skills, Doc?
It’s no secret that many Americans feel dissatisfied with health care. And the truth is, many providers feel this way too. Between insurance billing mazes, pharmaceutical industry pressures, chronic illnesses, and backlogged preventative care––everybody feels the strain.
So by the time a doctor actually sits down in front of a patient, the premise of their relationship is often already compromised. Doctors are often pressed for time and generally weary from an overwhelmed healthcare system, which impacts their ability to be “present” with their patients.
But beyond the usual discussion of “bedside manner,” poor communication between a doctor and a patient leads to poor efficacy and lower rates of healing. Unless there is a positive relationship in place, practitioners are less likely to recommend the most effective treatment for each unique patient, and patients are less likely to actually follow through.
So how can we change this dynamic? This article breaks down a few essential listening techniques that every doctor should consider practicing with their patients to positively affect healing, and build a fulfilling, successful practice.
Is Listening Really a Problem for Doctors?
Evidence suggests yes, it is.
Studies on doctor-patient communication have demonstrated patient discontent––even when many doctors considered the communication adequate or even excellent.
For instance, in one study, 75% of the orthopedic surgeons surveyed believed that they communicated satisfactorily with their patients, but only 21% of the patients reported satisfactory communication with these doctors. Further, patient surveys have consistently shown that they want better communication with their physicians.
You didn’t learn high-caliber cross-cultural communication skills in med school? You’re not alone—most practitioners don’t. Bedside manners tend to take a backseat to medical training, but now more than ever, our ability to communicate across many demographics is valuable in every profession. If you haven’t already had the opportunity to learn real listening techniques, here’s a chance to pick up a few new tools to put in your communications toolkit.
The Important Role That Listening Plays in Healing
“Medicine is an art whose magic and creative ability have long been recognized as residing in the interpersonal aspects of patient-physician relationship.”
–Judith A. Hall, Debra L. Roter and Cynthia S. Rand
Interpersonal skills are quite important when it comes to the way people feel, and heal. When a practitioner really listens to a patient, two very important things happen:
1. They get better data
Firstly, doctors are able to gather a plethora of data, which can then lead to their assessment and tailored treatment for each individual––rather than a standardized recommendation of care.
For instance, a doctor might tell a patient who smokes cigarettes that they should stop smoking in order to lower their blood pressure. But if the patient does not have the willpower to quit smoking, that will not be the best treatment for them. It’s undoubtedly difficult to help patients who refuse to change unhealthy habits. But, by meeting them where they are at, chances are, practitioners can have a better idea of treatments that might actually work for their patients. So perhaps instead of being pushed to quit smoking, the patient could be encouraged to smoke less, exercise more, eat more plant-based food, etc. The goal would be to allow the patient to self-identify actions they want to take, or will be likely to take, to move forward in a healthier direction.
There’s often a myriad of positive steps one can take towards healing, so recalibrating your recommendation based on the individual’s likelihood of following through can have an enormous impact on their health.
2. A better relationship = better healing
When a practitioner takes the time to truly listen to a patient, shared perceptions and feelings regarding the nature of the problem and treatment goals, as well as the feeling of psychosocial support, is established. A relationship is formed, and it is often on the strength of this relationship that healing can transpire.
Patients who report good communication with their doctors are more likely to be satisfied with their overall care. This makes them more likely to share pertinent information for accurate diagnosis of their problems, follow advice, and adhere to the prescribed treatment.
When doctors and patients are in alignment with the nature of the prescribed treatment and proper follow-up, there is also a strong association with recovery.
So, how can practitioners become better listeners? Here are a few easy tips:
Listening Techniques For Doctors
Everybody knows how to listen, right? You just be quiet while someone else is talking…
Listening is more than just being quiet while someone else is talking. Good listening allows the other person to feel seen, heard, understood, and validated–– even if you don’t agree with them. While feeling “heard” is nuanced, here are a few surefire steps to improve communication with your patients.
1. Ask (Bigger) Questions
So, what can I help you with today?
Most doctors ask at least a couple of standard questions when they sit down with a patient. However, these questions often only zero in on problems. This can keep the patient and doctor trapped in the downward spiral of pain management, which is an important component of healing––but not the entire equation.
Primarily, it’s important for patients to feel like they have all the time they need to tell their doctor the purpose of their visit. It’s equally important for practitioners to listen carefully, and accept what they are saying as being true for them.
But before the visit ends, be sure to sprinkle in a few bigger, zoomed-out questions, which can help patients envision their solutions, break out of the pain management discourse, and have a higher likelihood to heal.
Consider asking questions such as:
“What else has been going on for you?”
“What does optimum health look like to you?”
“What is one thing you can do every day that will help you feel the way you want to feel?”
These questions and others can give patients the opportunity to shift from being in a negative frame of mind to a positive one, which can not only proliferate healing but also establish a better patient-provider relationship.
2. Be Patient
A funny thing happens when people get asked personal questions. Some people love it, and have no problem sharing everything that’s going on for them––but many others are far less likely to open up.
Men, for instance, are less likely to go to the doctor, and when they do, they’re less likely to open up about their health. There are a few different cultural reasons for this, but mainly, there’s a stigma attached to men being vulnerable and admitting weakness.
People who have historically been marginalized from receiving positive medical care, such as African Americans, LGBTQs, immigrants, and non-English speakers can also be less likely to “open up” when they have time in front of a doctor.
But their silence doesn’t necessarily mean that nothing is going on for them, or that they don’t have something to share that would probably help you better diagnose and treat their condition(s).
If you think back to when you were in school, you might remember teachers asking questions, and the same students raising their hands to answer question after question.
Teachers who are adept at facilitating a room equitably, however, will modulate the room to ensure everybody gets a chance to speak––including those who are shy, or less likely to talk.
So, what’s the best way to go about this when you’re in front of a quiet patient?
Wait for them to respond.
Often, doctors ask questions and expect answers to come at a pace that is too quick for those who are less likely to speak up. By breezing through to the next question or quickly wrapping up the visit, a practitioner might not give them the opportunity to open up. With some people, it just takes time.
So if you’re silent for long enough, chances are, they’ll squeak out some information that’s probably important for you to hear.
If they still aren’t opening up, ask a few more open-ended questions until they do. Even a little bit of progress in one visit can lay down a foundation of trust, and they may be more likely to say more in their next visit.
3. No Judgement
Every doctor’s office should be a judgement-free zone.
But up to 80% of patients surveyed admit to lying about important information regarding their health to their doctor for fear of judgement, which can have a significant negative impact on health outcomes.
We get it––it’s hard to see patients struggling from chronic illness that could be greatly reduced or eliminated if they’d only change their unhealthy habits. But humans are complicated, emotional creatures. If it was just a matter of knowing what to do differently, most of our chronic conditions would be cured overnight. It’s clearly more complicated than that, and that’s where real, open-minded listening comes in.
When patients feel like they’re in a “safe space,” they are far more likely to tell you everything that’s going on for them. While some of this information can be hard to hear, it’s important to put on your “social worker hat.” Ask questions, and resist the urge to tell patients what they should be doing differently. For many people, just talking about what’s going on for them already accelerates their ability to heal from it.
It’s also important to note that according to the World Health Organization, 65 – 80% of the world’s population uses holistic medicine as their primary form of health care.
Over the past couple of decades in America, we’ve seen a huge rise in holistic forms of care–– whether its acupuncture, massage therapy, energy work, chiropractic, herbalism, dietary shifts, or others.
So it’s safe to say that a large percentage of the population at any given time is engaging in their own forms of healing, outside of the doctor’s office. Rather than discounting those forms of medicine, consider their safety (many forms of natural medicine are low-risk as long as they’re used in combination with, and not instead of, conventional medicine)… But do a little research, and if they’re seemingly safe and if the patient enjoys them, consider how your treatment plans can complement and include their self-designed methods, rather than discounting them.
4. Reflect Back
“So, what I heard was…”
After a patient tells you their complaints, the simple act of reflecting back to them what you heard can make sure that you heard correctly, and allow them to feel understood.
It makes it more likely that both of you have a clear assessment of what is going on for them, and what the best treatment should be.
The other component, after reflecting back, is affirming them.
When patients end up in the doctor’s office, they often feel clueless about what to do next and can want to place 100% of the responsibility of their health in your hands, as the doctor.
But the fact is, you’re not the one who gets to make important daily decisions for them––like what time they’ll go to bed or what they’ll eat, or how much stress they’ll feel or how much wine they’ll drink. As most doctors know, you can prescribe the best treatment in the world, but if the patient doesn’t follow through, it’s an exercise in futility.
For that reason, it’s important to have your patients to leave your office feeling a sense of empowerment, and to have you feeling a sense of accomplishment for having conveyed the message:
You know what is going to make you feel better.
You have the tools around you to cultivate better health.
I believe you can reach your health goals.
Affirm some of the positive decisions they are already making. Remind them that they are strong, capable, resilient beings, and that if they want to make a change, they can. By shifting focus from the problem to the solution (that is often already in their hands), you can set them up for a much better health outcome, while deepening a positive relationship.
There is a proliferation of tools and techniques that can help your practice grow, but at the end of the day, delivering a positive patient experience will help set yours apart from the rest. When a patient feels seen, heard and understood, they are far more likely to share their good experience with others, which increases referrals and helps your career flourish.
Most of the time, delivering a positive patient experience is as simple as taking the time to really sit and be present with a patient. The best part is that not only does this help your patient, but it can also help you feel more deeply connected to your practice and purpose.
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