Last week, we established that there are seven key skills that distinguish an ordinary doctor from an extraordinary one. We wish that these seven skills were taught to us in medical college. This week we discuss the first key skill – Listening.

Are Doctors Really Listening to Their Patients?

In my 34 years of experience as a doctor, I’ve had the chance to interact with patients, patients’ relatives, hospital managers and doctors. One of the things I’ve heard countless number of times is,

“I am very disappointed and dissatisfied; the doctor did not even listen to me!”

On the other hand, my own psyche and that of my colleagues would be,

“I heard everything that the patient said to me. I am certain about the diagnosis and have started the treatment. I don’t have time to listen to all her stories and imagined symptoms.”

Importance of Listening for Doctors

Is listening a natural ability that all of us have? In a survey conducted by Yelp, one of the most popular survey sites for physician reviews, listening was listed as the second most important skill needed by doctors to ensure patient satisfaction. Unfortunately, listening skills are a rarity in the physician population, which then forces us to ask the following two questions:

• Is listening a natural ability that all of us have?
• Is it actually possible to learn to listen?

In order for us to answer these questions, 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 has 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.

Hearing is a passive phenomenon by which sounds are perceived by the ear, i.e., hearing is all the auditory input that comes into our ear. However, listening is an activity that we consciously choose to do, when we pay attention to the speaker and what is being said.

Is Listening a Critical Skill for a Doctor?

This brings us back to the essential question: do we listen to our patients? I am reminded of the time when I was working in one of the largest private hospitals in Delhi, which had many renowned doctors. One of them was a phenomenon; the sheer number of surgeries that he performed was astounding. However, the constant feedback from his patients was that he was a great doctor but did not listen to them. In fact, after the surgery, he did not even meet with them. Of course, technically, the surgeon was sure about the surgery that he had performed and therefore, did not feel the need to talk much; the results would speak for themselves, wouldn’t they? There’s no fault with this line of thinking, but there is no denying that the patients felt dissatisfied, and a little extra effort could have transformed the feedback to “He is an amazing doctor who really cares!”

Listening is an important skill in any environment. However, listening is even more crucial to the medical profession because it is a commitment to understanding how the other person is feeling, and therein lies the crux of our job. It is also a compliment because it conveys to the other person that we care about what’s happening to them and in their life, and that their experiences are important. This is the heart of listening, and this is why it is a skill that can enhance the level of care we provide, save time and make us extraordinary doctors.

There is one step beyond listening as well, and that is active listening. It involves using the information gleaned and acting effectively on it. So, how should doctors listen actively? How can this critical skill of “active listening” be developed?

There are three steps to it, which if correctly imbibed into our way of working can enable us to be effective listeners.

Step 1: Defining the End Goal of Active Listening

Within a therapeutic setting, it is essential for the doctor or healthcare personnel to understand the patient’s concerns, feelings, thoughts and perceptions accurately. Medical professionals should always attempt to identify the following two things:

• What is the core message that the patient is conveying?
• What are the core feelings that the patients is experiencing?

Once we are able to correctly answer these two questions, we are in a position to modify our responses appropriately, thereby ensuring that the patient is completely satisfied. I have realised that most people are not good communicators, especially when they are ill. Often, they may not be able to put across these two points clearly; in fact, they may not even be aware about their core feelings!

It is critical to appreciate that once we have correctly identified these two issues we can choose and modify our actions, behaviour, communication and the words that we use so that they are appropriate and address the patients’ concerns. Hence, it is our responsibility as doctors to ensure that we accurately identify the core message and core feelings. Otherwise, patients often walk away feeling disappointed.

Next week, we will discuss Step 2 of Active Listening: “The attitudes needed for Active Listening”. This is part of a series on “7 Skills We Wish Were Taught at Medical College”.