Doctors' Listening Skills When people go to the doctor's office they want the doctor to listen. Competency and a correct diagnosis are appreciated too, but more than anything, patients value doctors's i lence (Richards, 1407). In addition, patients want "more and better information about their problem and the outcome, more openness about the side effects of treatment, relief of pain and emotional distress, and advice on what they can do for themselves" (Meryn, 1922). Doctors' technical role is in excellent health; it is their interpersonal role that is in intensive care. If doctors are to meet the needs of their patients they must first listen with an empathic ear and practice responsive communication. Sadly, most doctors have better handwriting than communication skills." Effective listening - empathic listening - promotes growth in the listener, the one listened to, and the relationship between them" (Nichols, 1995).
Being listened to makes you feel good. The father of listening, Ralph G. Nichols said, "The most basic of all human needs is to understand and to be understood... The best way to understand people is to listen to them." Doctors' can only treat physical ailments when they chose not to listen to patients' needs. Listening is the doctors' window to what is on the inside (Bently, 56). Susan Urba used to take a pro-active approach with her cancer patients, doing all the talking, informing them about the disease.
She learned her care was better received when she focused in on her patients' needs and fears first. "Giving patients the chance to tell us what's right for them can be hard," said Urba, "but how else can we know what they truly need to feel better" (Urba, 167)? Patients' come to the doctor because they are suffering. So, to be treated effectively, the doctor must recognize and treat the suffering not with quick advice or a bottle of pills, but by taking the time to listen to what the patient is saying. Even though doctors can never truly experience another's distress, they can do a better job at attending to their patients' needs by simply listening. Because medicine has often replaced an ear to the suffering, "physicians may inadvertently cause suffering or fail to relieve it when relief is possible" (Cassell, 24).
Empathic listening is the most helpful type of listening for a sender whose message is that of suffering, sorrow and pain. Empathic listening in the doctor-patient relationship involves three elements: an active communicative emotional commitment by the listener, an acceptance that role taking is necessary, and identification with the other party (Walker, 3). Active communicative emotional commitment and role taking refers to verbal, non-verbal, physical and mental behaviors. Sheila Bently lists these listening techniques in a Nursing Homes article that is directed at caregivers for the elderly, but is applicable for doctors as well. 1.
Focus your full attention on the speaker. 2. Get on the same level as the speaker. Sit or kneel by the patient. 3. Give verbal and nonverbal feedback.
4. Take the time to give some quality listening to each patient and do some relational listening. 5. Avoid giving advice that will negate the patients' feelings (i. e.
"you " ll be OK") 6. Let the patients talk about what he or she wants to talk about. 7. Give verbal responses that support rather than evaluate the speaker 8. Practice turn-taking. 9.
Smile, be pleasant and use humor where appropriate. The last part of empathic listening, identification with the other party, is the most important part and most difficult to practice. True identification with what the patient is going through is never possible. Doctors must put all of their energy into listening so they can try to relate with the patient as much as possible and diagnose the symptoms from the patient's perspective. The medicinal treatment is only one small part of what may actually heal a patient.
In talking to the patient, the doctor should make eye contact as much as possible in order to pick up on any nonverbal cues of distress, confusion or fear from the patient. "[Dr. Urba] realized there was no sense going any further. Instead of talking about toxicity and response rates, I needed to slow way down and realize where this patient was in his ability to deal with the disease... Patients can only take so much at one time, and therefore they must remind us when they need more time before moving to the next step" (Urba 169). Another positive skill for a doctor to use is to create a mental and physical environment in which the patient is built-up, not torn-down.
Research shows that patients are more satisfied and are made to feel more comfortable when doctors create an atmosphere of two-way communication. By asking open-ended questions, doctors allow the patient to tell their story and can see the illness from the patient's perspective. The research also showed that patients were turned off and often would end the relationship with their doctor if the doctor only spouted off a complicated explanation of the illness and did not stop to listen to the patient (Krupet, 24). The heart of doctor-patient communication is in the medical interview. That is where doctors listen to their patients' explanation of their illness and the doctor has a chance to ask pointed questions to deduct a correct diagnosis. In recent years, because of major communication problems which "can lead to misdiagnosis, increased malpractice claims and dissatisfaction with the medical profession" doctors have been encouraged to spend more time listening and less time talking (Braus, 16).
The complexity of the patients' illnesses reaches far beyond science. Research shows that as many of "75% of visits to primary care doctors stem from problems such as depression" (Braus, 17). When a patient comes into the medical interview complaining of medical conditions and only 23% are allowed to finish statements uninterrupted by doctors, there is a significant problem (Braus, 17). When it comes to the medical interview, times are changing. A doctor who attended University of Michigan Medical School in the 1970's said she remembers " a little course on interviewing which consisted of maybe a little talk. It was too minimal to have any impact" (Braus, 18).
The medical field has evolved to face the patients' increasing concerns of the interpersonal communication skills of their doctors. Medical schools have started new doctor-patient communication classes for which insurance companies are now offering discounts for doctors who take the classes (Braus, 18). Dr. Sandra Burford in Conveying Bad News gives advice to other doctors on how to convey bad news to a patient during a medial interview. 1.
Ask about the patient's knowledge or experiences with diagnosis no matter how benign you believe the diagnosis to be. 2. Be as supportive for additional bad news after the initial diagnosis as you have been for the first. 3.
Ask if the patient wants a friend, spouse, or companion at the consultation. 4. No matter how rare or interesting the patient's diagnosis may be, try not to tell the patient how unusual the disease is-at least not at first. 5.
Give the patient a hug (Burford, 8). One of the most interesting studies was the Physicians' and Patients' Perceptions of Actual Versus Ideal Physicians' Communications and Listening Behaviors. The doctors in the study had a mean of 19 years in practice. Only 25. 5% of the doctors reported taking a communication class in medical school. Of this group, 40% said that listening was the communication skill that was most often taught.
Specific communication skills that were taught in the classes consisted of "greeting the patient; showing concern and respect for the patient in your communication; providing feedback to the patients' comments and questions; paying attention to the patients' nonverbal cues" (Zimmerman, 152). The study found that both patients and doctors agreed on actual and ideal communication behavior. Both thought that the doctors' communication was non-empathetic, however, doctors said that ideally they would like to communicate empathically (Zimmerman, 161). The study concluded that doctors "have chosen not to communicate to patients in the way that patients feel they should be communicated" (Zimmerman, 159).
One reason the study offered as possible explanation of why this contradiction exists among some doctors was derived from an interview with a health care consultant." Traditional doctor training means a grueling residency in a hospital, incredibly long hours, and intense instruction in the science of medicine. Sometimes it turns young people into assembly-line physicians who don't even bother to learn their patients' name" (Zimmerman, 160). All of the studies we looked at speak to the problems of the communication behavior of doctors with their patients. Although, none of the articles had extremely concrete statistics to the problem, we found no studies that refuted doctors' problems with listening and conveying information in a clear, understandable and empathic way.
Many of the programs written about in journals which have been started in the last couple of years to educate doctors on the need for better communication skills have not been in place long enough to show whether or not progress has been achieved in this area. As students in medical school become more and more advanced in their understanding of scientific discoveries such as the mapping of the human genome, the schools need to continue to put much more emphasis on the human side of science. We believe one possible way this issue will start to heal will be the continuing trend of women practicing medicine. Male doctors have much to learn from their communicative superior counterparts.
In a study done at Northwestern University comparing how male and female doctors communicate with their patients, "women were found to spend more time with their patients, asked them more questions, used less technical language when they were talking to them and smiled and nodded at them more often" (Kaukas, H 1). As the ratio of women to men becomes closer, male doctors will observe the positive response from patients from maternalistic medicine. Doctors could also learn a lot from nurses." While doctors and nurses evaluate and respond to her physical symptoms, Janet Craig is working on another diagnosis-a nursing diagnosis-of the girls emotional needs. Craig concentrates on reducing her anxiety about both her condition and the technical interventions escalating around her.
She sees that the girl is becoming very agitated and that this might aggravate her condition. So she tries to calm and reassure her, explaining what the doctors and nurses are doing and why" (Gordon, 2). Nurses tend to both the physical and emotional needs of the patients. "While doctors focus on a limb, heart, or lung, nurses implement the medical regimen that physicians prescribe, and monitor the intricate human needs of those whose cells, limbs, or organs are diseased and dysfunctional" (Gordon, 2).
They explain procedures, discuss options and form relationships with patients, establishing a system of trust that enables them to better assess the patients' needs in healing from or coping with an illness. Nurses outnumber doctors in a three to one ratio, and during a hospital stay patients will spend less than one hour out of five days on average with their doctor. In a hospital, the patients interact with nurses (Gordon, 2). Does this present a solution to the communication problem that we have raised? Perhaps it is a system that works in hospitals, but less in the medical interview at a family physician's office.
In addition, it is the physician, not the nurse who diagnoses the patient after the medical interview. The research is conclusive: doctors need to be trained in empathic listening. There is not however enough research to conclude whether the conditions are improving. Many suggest that the economic needs of the doctors and the ever-expanding amount of scientific information that doctors must study will continue to overshadow the need for communication training. In order to spend time listening to patients, doctors must see fewer patients and to receive communication training in medical school, students must forego other types of medical training. The medical community is aware of the problem, and many are attempting to find solutions.
More studies must be conducted to determine which if any of these solutions are resulting in more empathic doctors. The medical community must also rank its priorities. Which is most important: scientific advancement, economics, or people? The ways that medical training is adapted will determine the answer in the decades to come. Works CitedBently, Sheila C. "Listening Better: A Guide to Improving What May Be the Ultimate Staff Skill." Nursing Homes, v 47 n 2 p 56 (3), 1 February 1998. Braus, Patricia "A Talking Cure." New Physician, p 16+, 1 November 1992.
Burford, Sandra "Conveying Bad News- With Care." Patient Care, v 31 n 11 p 8 (1), 15 June 1997. Cassell, Eric J. "Recognizing Suffering." Hastings Center Report, p 24 (8), May/June 1991. Girzaitis, L. "We Listen with our Hearts." Listening, A Response Activity, MN: St Mary's Press. Gordon, Suzanne "What Nurses Know." Mother Jones, 40 (7), Sept/Oct-1992.
Kaukas, Dick "A Woman's Touch." Courier-Journal, H 1+, 1 May 1994. Krupet, E. "A Delicate Imbalance." Psychology Today, p 22 (5), November 1986. Meryn, Siegfried "Improving Doctor-Patient Communication: Not an Option, but a Necessity." British Medical Journal, v 316 n 7149 p 1922 (1), 27 June 1998. Nichols, R. "Listening: Questions and Problems." Quarterly Journal of Speech, p 3383 (4).
Richards, T. "Chasms in Communication." British Medical Journal, p 301 1407 (2), 1990. Urba, Susan "Sometimes the Best Thing I do is Listening." Medical Economics, v 75 n 9 p 167 (4), 11 May 1998. Walker, Kandi L. "Do You Ever Listen? : Discovering the Theoretical Underpinnings of Empathic Listening." Journal of the International Listening Association. Zimmerman, R.
"Physicians' and Patients' Perceptions of Actual Versus Ideal Physicians' Communications and Listening Behaviors." Journal of the International Listening Association, vol 4 p 143 (22), 1990.