Chapter 6 Listening 167NAME: Tammy Lin
OCCUPATION: PhysicianEffective listening
in medical contexts
means give-and-take
between doctors and
patients with the goal of promoting better health
and wellness. As a physician specializing in inter-
nal medicine, I think of this daily. For my patients’
maximum therapeutic benefit, I must listen closely
to them—and they must also listen to me. The
answers to patients’ questions often lie in their
stories, and for me to make an accurate diagno-
sis, I must actively listen and elicit the necessary
information.
I like to think of listening to my patients as a
process of discovery. Coming up with an accurate
diagnosis and devising an effective treatment plan
can be a puzzle. I have to search for as much
information as possible about patients’ health—
such as what they eat and drink, what drugs
(prescription and nonprescription) they take, what
toxins they may have been exposed to, and what
exercise they do (or don’t do). This might seem
like a simple question-and-answer method, but
there are often roadblocks. For example, some
patients are incredibly anxious when speaking
with a doctor or are too embarrassed to give
truthful answers (particularly about issues like
diet or mental health). Still other patients seem
to withhold information to see how “good” I am
at figuring things out on my own. In all of these
circumstances, it’s up to me to put the patient at
ease by opening with generally “safe” questions
and easing my way into more difficult topics.
Knowing how to listen is an essential skill that
allows me to do my job. With every patient, I focus
on giving my full attention, not interrupting, and
remaining open to whatever the patient would like
to tell me. Nonetheless, my patients also have an
obligation to be engaged listeners and honest partici-
pants in their own health care. Clearly, it’s important
that they listen in order to understand the options
they have for treatment, and I encourage them
to paraphrase the information I’ve shared. (When
patients paraphrase in their own words, it shows
that they comprehend what I’ve said. Asking them
to repeat my exact words is not particularly helpful!)
I also welcome and encourage questions, letting
patients know that no question is too silly or simple.
If I’m giving complex instructions (like information
on taking a medication at a specific time of day), I
either encourage patients to take notes or provide
them with written materials they can bring home.
Sometimes the process of writing down the informa-
tion helps patients process and absorb it. Because
patients may be distracted during their visit, they may
not fully understand or remember what I tell them.
A particularly difficult listening challenge
involves sharing and hearing bad news—like the
diagnosis of a life-changing or potentially terminal
illness. I always anticipate the patients’ shock and
watch their nonverbal communication to gauge
how much information they can absorb at the
moment—and what needs to be saved for later. It’s
simply not beneficial to spew off facts and treat-
ment options to someone who is flushed, breathing
rapidly, or crying with her head in her hands. Simi-
larly, I hope that my patients are also monitoring my
nonverbal cues in such situations. If I tell a patient
that he has type 2 diabetes, for example, I use a
serious tone of voice and somber facial expression
while maintaining direct eye contact. It’s essential
that the patient sees me taking this diagnosis seri-
ously so that he is aware of the seriousness of the
lifestyle changes he’ll need to implement.
The next time you see your doctor, remem-
ber that it’s a mutually beneficial listening proc-
ess. For a physician to arrive at an accurate
diagnosis and come up with a successful treat-
ment plan, the patient must be prepared to share
all of the information related to his or her health
situation (for example, current medications,
recent life changes, and so on). Before your next
visit, write down your questions and don’t be
afraid to ask about anything you don’t under-
stand. Be prepared to listen to your doctor, and
help your doctor listen to you.real communicator