Thinking about listening.

It seems like at times there is a complete breakdown in listening – the recent “astroturf”-hijacked healthcare town hall discussions being a rather extreme example.  Of course, this easily – and understandably – happens when emotions are high, and when the participants of any given discussion don't know each other.  Time and place matter too; the internet is not always the best meeting hall, and sometimes (as we occasionally see on this blog), some participants will try to force a discussion that might more profitably happen somewhere else (e.g. on another website, or perhaps in person, or on “Jerry Springer”).  I wonder if this is partly because most of us read much faster than we talk.

I like to get my news from the radio.  I’m already on the internet too much to read it there; the local papers only deliver a few days a week (and NYT delivery is too spotty to be worth it); and TV news is too much stimulation (if it’s already bad news, I don’t want to see the footage of it)!  But I can listen to radio news while I cook dinner, and the combination of narration and soothing mechanical activity works well for me. 

Recently I happened to hear part of WHYY’s “Fresh Air”; the guest was Dr. Lisa Sanders, who writes the “Diagnosis” column for the NYT and is also a consultant for the TV show “House.”  She has a new book out, “Every Patient Tells a Story.”  In the interview, she talks quite a bit about diagnosis and the importance of physical exams, and it’s all pretty interesting stuff, but the part that struck me was about the importance of listening in making a diagnosis.  Apparently, a couple of studies of doctor-patient interviews have been done which show that, as she says, “half the time, a doctor and a patient will not agree on what the purpose of the visit was about” (this is after the visit, when questioned separately).  I thought, “this is something that we acupuncturists would do well to keep in mind.”  Dr. Sanders went on to say that studies have shown that doctors interrupt their patients’ narratives after 20 seconds or less, on average; when the average narrative only LASTS two minutes.  This REALLY struck me.  Two minutes!  Who needs 45 minute intakes?  Sure, you have to ask some clarifying questions; however, questions that would lead to an acupuncture-oriented diagnosis (which is what you want when you’re doing acupuncture, right?) are relatively few and simple.  So, say on top of two minutes of patient narrative you add three more minutes of “where does it hurt exactly” and “what makes it better/worse” and “does this hurt?” – and it seems to me that you can easily do a relatively thorough INITIAL intake in less than 10 minutes.  That’s with some real good listening built in!

Clearly listening is a skill, and a difficult one to master; especially when what is being said is upsetting in any way.  Naturally, as healthcare practitioners, we hear upsetting things every day; maybe this is why some of us (yours truly included) might have a slightly short fuse outside of the clinic.  I don’t think I’m any better at listening than most people, and I’m terrible at giving advice – even when patients ask me point blank, I most often don’t have any to offer.  (My feelings about “lifestyle advice” are pretty much echoed in this excellent post on the blog “Shapely Prose.”)  Of course, just saying “keep coming back for acupuncture” can potentially sound a little self-serving.  So mostly, I just try to encourage people (nonverbally as well as verbally) to trust themselves.  The nonverbal part is important; it’s part of how we show we’re listening.   I try to listen to patients’ words, and it also feels like listening to “tune in” to their body language, to their pulses, to the feeling under the needle.  In lieu of advice, I try to help them listen to their inner authority – not because I believe so much in individual health, but because I believe in some kind of democracy.  I hope that makes sense; I’m still trying to tune into what this all means, to find the words that you can hear, and that are still true for me.

Author: noraneedles

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  1. .

    awesome nora. i cant wait to listen to the show, it sounds really interesting. this really makes me think about the “doctor” approach that we get taught is so necessary and even fall in to ourselves sometimes. take control of the conversation,be the expert, and guide the entire interaction and treatment to your whim of the moment. its been clicking with me a lot recently how self indulgent our schooling and profession can be. thank god for all the bright bright lights out there changing that

  2. Great post Nora! I like the

    Great post Nora! I like the way you refer to the experience of listening as receiving a mix of varied sources of information. “Listening” to patients for me feels like carefully sensing a feeling or vibe that is being unconsciously shared by another person. This vibe is a mix of particular styles of self expression; fast or slow physical movement, loud or soft voice, tense or relaxed body, and active or quiet pulse. All these signs come together quickly in the clinic to form a general and specific impression-mood-vibe. It takes careful listening to catch a clear impression in my experience. I can always get a general impression, we all do that all day long in everyday interactions. Truly listening is pretty simple yet not always so easy. It takes work from my experience. It also pays off big time in building trust with our patients. Glad you brought it up…

  3. Listening

    Dr. Jerome Groopman book, “How Doctors Think” is a good, quick read that discusses this issue in detail. Also lots of other good mistake that I have made over the years. Check it out.

  4. Nice post, Nora. I heard

    Nice post, Nora. I heard that show, too, and came to the same conclusions. Best to just listen for a a few minutes then focus mostly on the non-verbal “objective” presentation.

  5. I love the part about the two minutes.

    That’s something to think about, that what most people want is just to be listened to for two minutes straight. Another bit of confirmation that people aren’t really demanding, and what they want is pretty simple.

  6. Great post

    I keep thinking about how listening is something that patients want us to do, and although it is important to a certain degree, it can be challlenging particularly when faced with the clock and the care of other patients already being treated. 

    There have been times when I have (as I’m sure all of us have), as graciously as possible, tried to stop a patient from talking during their intake or follow-up session, because all the words coming out of their mouth were really extraneous and time-consuming.  I also think it’s okay to do this because it gets them to stop fixating
    on all their problems by talking about it again and again, and gives
    them the space to just stop, be quiet and have time to heal – to really get what they came to my office for. They didn’t come to my office to talk to me about their pain; they came to get needles stuck in them so the pain would go away. 

    This reminds me of a recent situation where a new patient came in with the things we normally treat – low back pain, neck and shoulder pain – and attempted to tell me every single diagnosis he’s ever had and every surgery – and yet, what does it really come down to in order for him to be effectively treated?  Where the pain is located and how bad it is.  And so I told him that, and he gave me the simple answers, and we proceeded to the treatment.  I gave him the same treatment I’d give pretty much anyone with low back, neck and shoulder pain (depending on the location of pain, of course), regardless of the western diagnosis. 

    And you know what?  He got out of the chair and couldn’t believe how much better he felt.  And that is really what matters. 

  7. Listening

    There is a book I often recommend to patients, friends and especially other acupuncturists. It’s called Kitchen Table Wisdom: stories that heal by Rachel Naomi Remen. It really helped me to become a better listener.