What Patients Want: Listening (or, Only Fools Rush In)

Posted: Fri, Jul 25, 2014 15:39

Take a minute to guess how long it takes for a doctor to interrupt a patient during a consultation.

Got your answer? Was it somewhere around two minutes? One? Less?

The average amount of time it takes for a male doctor to jump on a patient’s initial description of their experience is only 18 seconds. Within 18 seconds, they’re asking questions. How does that make the patient feel? What does it do for their ego or their sense of control if we don’t listen to them?

Consider This:

Make sure you say “uh-huh” three times to the patient before you jump in with a question, and listen for what isn't said. Establish rapport by hearing what the symptoms are and deducing what they mean to the patient.

Remember: you’re talking about the disease, but your patient is talking about how the illness is going to impact him. He’s asking himself: when am I going to go back to work? Will I be able to support my family? Will my life ever be the same again after this? Am I going to feel like my old self? When this illness goes away, is anything going to resemble what I once knew? That’s where his head is while you’re talking about the disease, so it’s important to consider the impact of the illness as well.

Active Listening

When you’re actively listening, you want to use head nods and say “uh-huh,” “I see,” “mm-hmm,” and “tell me more.”

Your voice is an instrument, so use it! Vary tone, speed, and inflection. Beware of an authoritative voice (otherwise known as I’m-here-because-I-know-everything-and-you’re-going-to-listen voice). It’s proven to work against everything that you are trying to accomplish. An authoritative voice is not the message we want to get across. Vocal confidence, yes; vocal arrogance, no!

Dr. Mehrabian taught us that communication is 7% words, 38% tone of voice, and 55% body language. Make sure that your words, tone, and body are all communicating the same message. If one contradicts the other, you can seem disingenuous.

Special note for ED doctors: even though the environment is fast paced with a lot going on, but that’s no reason to do less than your best to make a good first impression. You may see that patient only once in the ED, but there’s no time to correct the impression you made. First, relax your face. Start with a warm, personal introduction. Authentically listen to hear the underlying emotions and fears of the patient so that you can address them. Why not add this question to the patient’s intake questionnaire: “What do you hope to get out of this visit?” Then the ED doctor can get a jump start on deciding what the plan of care is, finding out what that patient really is hoping to accomplish, and if you can’t meet that patient’s expectation, you have to be skillful enough to successfully manage it. It’s a magic question that really helps. It should be asked all over the hospital, but it really helps in acute and ED.

“Did I cover everything to your satisfaction?”Be sure the patient internalized what you said. ““I want to be confident that you understand the plan of care we’ll take together to make sure that you get better as soon as possible. Could you summarize the strategies we've discussed to return you to good health?” Then listen. Take your time, be patient, have positive expectations, and keep those eyebrows up to show attention and interest.

Make sure you clear up any misunderstandings. You can give the patient an opportunity to have his voice heard, to tell you his expectations, preferences, and fears. You can remind the patient that “Hey, there is no such thing as a silly or foolish question when I’m in the room with you... I am going to listen and respond.”

Conclude the visit by politely thanking the patient for giving you the opportunity to care for them: “Thanks for letting me take care of you. I realize that (whatever the malady is) is of great concern to you, and I want you to know that I take your health very seriously. How are you feeling about our visit today?”

The Take Away:

If you’re talking, you’re not listening. Make sure that you let the patient explain their experience and listen carefully to what they (and what they don’t). Have a strategy for managing patient expectations, and make sure that the patient understands your instructions. Practice active listening!

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