August 23, 2018
The other morning I passed by a very happy-looking little girl, probably about four years old, as I walked into my favourite local coffee shop. She was drawing in a notebook while her dad visited with a friend. I watched what at first looked like a pleasant scene quickly take a turn for the worse, as the little girl asked the two adults to “stop talking." Then she started chanting, “please stop talking!" She repeated it several times, each with increasing volume and frustration, until her father and his friend stopped their conversation and redirected their attention to her. “I just want you to listen to me!" was the next thing out of her mouth.
The whole thing made me think about our conversations with one another as adults. I wonder how many of my patients and co-workers wish they could make this little girl's simple request.
We've had pretty good evidence for over 30 years that physicians commonly and quickly interrupt patients after we ask some version of “what brings you in to my office today?" In 1984, the patient was interrupted 69 per cent of the time, and the average time before interruption was 18 seconds. In 2004, physicians interrupted patients 74 per cent of the time, waiting only an average of 16.5 seconds before talking. And, despite increased awareness of our tendency to interrupt, we continue to interrupt sooner: the
most recent study, published just last month, found that now when we interrupt we do so, on average, after just
11 seconds of listening to our patients.
Are we actually listening at all? If I'm going to be honest with myself, often, even when I think I'm listening, I'm actually just waiting to talk. Steven Covey, widely recognized around the world as a business and management thought leader, has said: “Most people do not listen with the intent to understand. Most people listen with the intent to reply." I know in meetings I'll catch myself planning my witty and compelling counterargument rather than actually pausing and reflecting on what I am hearing.
Interrupting and not actually listening are two pretty risky behaviours, whether we are working with patients or colleagues. With patients, we risk missing key pieces of information that can better inform our differential diagnosis and subsequent care plan. With colleagues, we risk making uninformed decisions or assumptions without fully assessing the situation.
Active listening, which is about more than simply not interrupting, is a learned skill. Active listening requires you to really pay attention to what the other person says, not just with their words, but also through their body language. Active listening requires putting aside your own opinions and withholding judgement so that you can truly be open to another person's ideas, perspectives and new possibilities. It also involves working to really understand what the other person is saying, by asking open-ended questions.
Becoming a better, more active listener is something we can all strive for, whether in conversations with patients and families or with each other. We work hard to teach this skill to our
learners. Are we willing to try to teach it to ourselves?
As always, let me know your thoughts at
firstname.lastname@example.org. I'll try my best to really listen. :)
Dr. Susan ShawChief Medical Officer