Monday, 3 October 2011

I wasn't listening before, but I promise I am now.


Last week, I was having a chat with my consultant. Forgetting that this is the chap that I may someday need a reference from, I took the opportunity of his monologue to check some emails on my phone, and fire off some quick replies. ‘Don’t stop,’ I said to him, ‘I’m still listening.’

‘No you’re not.’ he replied

I mumbled some platitude about being one of those blokes who could actually multitask, but he was right - I had decided that I didn’t need to listen too closely because I already knew what he was going to say.  

The following day, I gave a talk, and experienced the satisfaction of knowing that it had gone down pretty well. After the end of the session, one lady came up to me and told me that she had enjoyed my presentation thoroughly, and that she knew that everyone else had too, ‘Because you could feel it.’

I know what she means - there is a certain feeling you experience when you are talking to a room of people who are paying attention, but I have always thought that it is more of a sound: you hear it rather than feel it. I think it has something to do with the fact that attentive crowds fidget less, cough less, tap on their phones less, and consequently achieve a silence that one rarely hears. The point, however, is that it is a very nice experience. And one, apparently, that I am not prepared to extend to my boss.

This realisation has got me thinking about what it means to be heard, and what it means to listen. I have been struck by the number of bad habits that I seem to have developed. For example, when I am on-call (this is a euphemism for being busy) I often use the time that the patient is talking to think about how I am going to investigate and treat them, which patient I am going to see next, what I might have for dinner, how I might try to win my next squash match and so on. It was disheartening to realise that I use very little of that time to actually listen to the patient and give them my full attention.

A medical maxim is that the diagnosis is always in the history and rarely in the examination. This is true, but in my case, the diagnosis is often in another doctor’s history, which they then tell me.

The way we work in medicine means that there is often a lot of duplication of effort. Let me explain - I send a house officer or SHO off to see a patient, and they come back and tell me what has happened and run over what the plan should be. Sometimes I will have to go over certain aspects of the history with the patient myself, and partially repeat the process that the other doctor has already gone through. My consultant will then repeat this process with me. Even when I see the patient from the beginning myself, that patient has already been seen by a doctor in A and E or their GP - those are the entry criteria for the attention of the on-call medical registrar, so it must seem like Groundhog day for them.

Between presenting to a doctor with a problem and being treated for the problem, a patient can expect to be seen by upwards of 4 doctors, often all asking the same questions. This must be insufferable.
We all know the importance of asking opening questions, and it can be a particular skill to resist the temptation to ask more specific, closed questions when one is busy, but I guess that it doesn’t matter what kind of question that one asks if one is not actually listening properly. Speaking to a patient doesn’t only have to involve finding answers, or monitoring progress - there is therapy in the conversation itself, and there is reassurance in the being heard.

Doctors in general, and this one in particular, have a habit of being goal-orientated, and trying to ensure that each particular experience achieves an outcome. What I have realised is that a goal in itself is allowing people to know that they have been heard. It does not matter if nothing they tell you has a material difference on what you do for them, the experience of knowing that you have been listened to is a powerful and important one.


This week, therefore, I am planning to shut up and listen. Even on Thursday, when I am on-call.  

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