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Healing by Hearing
The Listening Practices of Exemplary Physicians
Listening is at the heart of good medicine. Indeed, patients want their stories heard. It is a simple premise, but a challenge to put into place in medicine, where the average doctor’s appointment face-time lasts only about six minutes.
In a first-of-its-kind study, Bentley professor Helen Meldrum discovered the degree to which award-winning humanitarian doctors put effective listening on the top of their list. Her project covered “exemplary” physicians named by the American Medical Association Foundation.
Meldrum’s study found that listening is essential, even for the busiest and most accomplished physicians. In fact, these doctors characterized careful listening as one of the most important aspects of their work. Listening is not simply a kindness or an optional response; it is vital to successful patient outcomes.
Good listening goes beyond hearing words. Interpreting patients — what they are saying, what they believe their bodies to be saying —opens up the physician to a patient’s human experience, beyond test results or other scientific data. It helps physicians to perceive and negotiate underlying clinical issues.
The themes identified in Meldrum’s study — empathy, understanding and shared decision making — were a consistent thread in the doctors’ experience of listening. Trust, understandably, was particularly salient. Indeed, it is the cornerstone of active listening, because patients open up once they feel a sense of trust. Feeling listened to, and trusting a doctor who listens well, helps patients adhere to treatment plans.
What is standing in the way of good listening by doctors? Time pressure is certainly a factor. In addition, developing key traits such as compassion and empathy have only recently become a focus in some medical schools. Other medical schools, Meldrum notes, claim to teach the skills via role-modeling during internships, but there are often gaps in this type of education. Active listening takes time to develop, and medical students must work to strike a balance between objectivity and compassion. Overall, Meldrum believes that medical education in the U.S. needs to invest greater time in listening training to create more effective collaborations with patients.
Cost is also a factor. Meldrum predicts that listening skills will be more highly valued when healthcare administrators recognize the link between cost-containment and effective interpersonal rapport. Feeling listened to is important in helping patients follow treatment plans, which is a key issue in this era of “Accountable Care Organizations.” Taking a few extra minutes to listen actually saves more time and expense by more effectively getting to the heart of the matter.
With a prevailing U.S. healthcare model that imposes unwieldy time constraints Meldrum's study shows the value of listening both to the patient and the healthcare system.
Good listening goes beyond hearing words.