An essay of mine won an award recently in a well-known medical journal. The piece describes one of the most troubling cases that I’ve encountered in my medical career.The story centers on a young girl and her rare medical condition. The story emphasizes the point that our sophisticated medical establishment is capable of failing not only to cure disease but also to care about people. The fundamental problem in the story, I think, is that physicians were not listening to the patient.What is listening, anyway, and why is it important?
Without becoming pedantic, I think it’s necessary to distinguish between hearing and listening. Hearing is the physiological phenomenon that begins when sound is processed by the eighth cranial nerve. Listening, on the other hand, is a skill. The element that separates hearing from listening is the significant act of paying attention – of attending to what the speaker is saying. A simple equation would look like this: hearing + attention = listening. As I write, I’m waiting to have a haircut. The owner of the salon is making small talk with me, but there is a fundamental problem. I cannot understand a single word that the owner is saying. In the background, the energetic new Adele CD is blasting. All around me, hair dryers are blowing. The salon’s illumination just needs a strobe light to be considered vintage disco. "How can I listen,” I wondered, “if I can''t even hear?”At that moment, something unexpected occurred. The owner looked at my laptop to see what I was writing then gestured for me to follow him outside. There, I could hear what he wanted to tell me. He seemed excited to let me know about a conversation he’d had with his older son, who is being groomed (ugh, bad pun) to enter his father’s business."You won''t believe this, doc,” he told me, “but the other day; I asked my son which type of physician he thought we barbers resemble. The kid immediately shot back ''surgeon,’ thinking of a barber’s dexterity with scissors. Then I set him straight. We''re really like psychiatrists because our clients want us to listen."I was fascinated by his remark, so I Googled and found an article in the Daily Mail about the most expensive hair stylist in London, a man named Stuart Phillips. According to the Website, exclusively, Phillips’ clients are celebrities and Russian oligarchs willing to pay 20,000£ for a single haircut. "For that price" explained Phillips, "I give them my undivided attention." I should hope so! Perhaps a decent coif too.
Let''s jump back to my profession for a moment. When I was a senior medical student, the school assigned a Career Guidance Counselor to help me sort through the various specialties that interested me. The counselor advised me to be sure to select a field "that had a fall back procedure". What she meant was that neurologists can always fall back on spinal taps; gastroenterologists, on colonoscopies; cardiologists, on angiographies; and so on. In the field of radiation oncology, however, doctors don''t directly administer treatment. Technologists push the buttons. I wondered what I would "fall back on". But then I realized that for cancer specialists, listening is our procedure. For most of us, hearing is relatively easy. But listening, really listening, can be a challenge. When a person talks to me, I wonder what message they’re trying to convey. Are they uneasy? Are they confident? Do they hope I''ll be able to comfort them? For me, listening requires making use of not only my ears but also my eyes and my mind, so that I can pick up subtle signals and understand contexts, to help to clarify the meaning of what is being said.When people don’t listen to me, I sometimes want to scream, not because I think the increased decibel level will help, but because I think that their not listening reflects a lack of interest in me.
Most of us can become better listeners. In order to remedy my own listening inadequacies, I try, after a conversation, to give myself a three-part test. Did I refrain from interrupting the other person? Did I attend to non-verbal aspects, such as tone, facial expression, and body language? Most important, did I let the person speak more than 50% of the time? If I can answer those questions affirmatively, then I feel that I did my best to listen.
We live in an age where the most experienced doctors are referred to as "senior physician" or decorated with stuffy titles like "professor". Back in the day, during simpler times, the title would’ve been "attending physician". By tradition, professionals were respected for their diagnostic abilities, for their knowledge, and particularly, because they knew how to attend to their patients. In short, they knew how to listen.
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