Hidden in plain sight is the most important procedure we do. Listening. And not just listening, but listening to understand. Measurable, improvable, and, when done well, can have an incredibly positive impact. Intention is key with listening: are we doing it to understand or to win? In this episode, we break down specific strategies for quality listening, potential pitfalls, and how to know when you’ve got it right.
Guest bio: Lon Setnik MD is an Emergency Physician and Associate Director of Clinical Programs at the Center for Medical Simulation.
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In this episode, we discuss:
The concept of listening as a procedure:
- It is a set of actions that we can train on and we can learn. When done repeatedly, it can get a clear outcome.
- The quality of listening can be measured with a specific target goal.
- The person with higher authority can affect the conversation by modeling the behavior they want the other person to adopt.
- Patients and family members often enter medical experiences with a barrier and defense shields up, so clinicians need to model open listening to create a more productive conversation.
Two modes of listening
- Listening to understand
- Analyzes the content and emotions of someone’s point of view by separating their identity from it.
- Focused on the experience the speaker is describing and not the words being used
- Understands the other person’s perspective and the ultimate goal is to find the best solution
- A mindset shift that can help with listening to understand is taking the perspective that the patient has special knowledge that we need to know. That special knowledge is why they came to see you today. The normal run of things is that we think that WE are the ones with special knowledge to give them – that we are there to teach and they are there to listen.
Listen to understand and get to that point where the person communicates to you that you got it.
- Listening to win
- Listening to what someone is saying with the intent of proving them wrong and winning the argument.
- Can be effective when someone is trying to teach you something and you want to understand the details by picking them apart.
Specific ways Lon listens to understand
- “I get the first couple sentence of their complaint, and I say, so what’s most important to you right now?”
- Don’t answer emotions with facts.
- If someone is anxious about a procedure and asks, “Have you ever done this before?” We usually answer with, “Oh yes, 500 times!” Thinking that will comfort them. It comes from a good place and might comfort them but the skillful move is to identify what they’re going through, “I sense that you’re nervous about this, tell me about it.”
How Rob separates the problem from the person
- Avoids “You” language in favor of “The” phrasing.
- Instead of, “You seem nervous,” which might raise the patient’s defenses, he favors, “I’m sensing frustration or I’m sensing some anxiety.” This can come across as less judgmental and more discerning.
The external marker of quality listening
- You aren’t the best judge of quality listening. It’s the speaker who gives the external marker of success
- If you can reflect their thoughts back to them and have them respond with something akin to, “That’s exactly right,” you’ve made it. That is listening to understand.
Finding the optimized solution in patient interactions
- Negotiating is not finding a compromise but coming up with the best outcome for both parties
- It is important to validate understanding through active listening and help narrow the hierarchical gap between physicians and patients.
- The most common optimized solution is when the patient is educated and empowered to make informed decisions
Negotiation strategies for success
- Say no to the question, not the person
- Separate the person from the emotion and examine it objectively.
Active vs empathic listening
- Active listening is being fully present in the conversation. It drives us to do something such as paraphrasing or reflecting. Oftentimes, this is not enough.
- Empathic listening involves both content and emotion. It is understanding the speaker’s meaning and the feelings he or she is expressing.
- By investing time and effort to listen with empathy, and to reflect on the information shared by the patient, we can proactively address these potential barriers.
- When patients feel involved and heard, they are more likely to adhere to agreed-upon treatment plans and take ownership of their health. This can lead to more effective and efficient patient visits.
- How to stay present
When we can stay fully present and focused, we can better identify and address patient concerns. It’s easier said than done!
- When you feel your mind wander (which it is wont to do), notice it and remind yourself to ‘come back’. Rob uses that exact mental phraing, “come back” to return to presence and focus. This is followed up by the question, “Am I listening?”
“We can prepare people to be ready to hear our side by us being ready to hear their side first.” – Lon Setnik MD
“We actually don’t know what we think until we get to say it” – Lon Setnik MD
“If we listen to our patients really well, sometimes we don’t have to do those low yield tests because oftentimes we’re where we’re helping ourselves in those moments, and it’s actually in conflict with what the patient wants.” – Lon Setnik MD
“When you are in that calmer, less sympathetically activated state, then you can engage empathy” – Rob Orman MD
Why we shouldn’t explain feelings with facts by Laura Rock in BMJ
Tiny Habits: The Small Changes That Change Everything by BJ Fogg, PhD
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Connect with Dr. Lon Setnik: