Listening…Better

It is a spectacularly dreary day here in DC, and the rain just doesn’t want to end. So I am looking for all things motivating this morning, because there is significant appeal to crawling back into my giant white cloud of a bed and spending the day working in my pajamas. As is so often the case, a morning dose of TED seems to be doing the trick.

From time to time I have conversations with colleagues at various training events about how people chart the patient narratives obtained during exams. There is great debate about whether we should be simply writing every word, as is, or whether we should be paraphrasing as appropriate. I am personally a paraphraser, weaving in select quotes where useful to describe something very specific, very vivid that may lose it’s impact with my interpretation. But I don’t think it’s necessarily the right way to chart–just my way. I think the idea of paraphrasing makes some of my lawyer friends a bit nutty, actually, because it leaves the door open to accusations that maybe I got it wrong, or maybe my paraphrasing was colored by bias. I suppose that’s a possibility, although fairly unlikely.  For any of us who work in this field, listening is a skill that is as well-honed as any other aspect of the patient encounter. I am, in fact, a professional listener.

As clinicians we can’t be effective if we don’t listen. Skilled listening is not just about taking down the information accurately–it’s about understanding context and impact. It’s about letting silences be; about understanding why a simple and well-placed phrase like, “I’m so sorry this happened to you” can be more healing than anything else we have to offer patients. Listening is not just about receiving and recording. It’s about recognition and empathy and human connection. Those of you who know me know that I may be one of the least touchy-feely (and one of the most frenetic) people walking the planet, but I am transformed when I work with patients. I have the attention span of a fruit fly, but I can be positively still for an endless period of time if that’s what is needed in the moment.

All of this leads me to the ultimate point of this post: listening may be one of the greatest tools we have as clinicians, but it needs to be finely tuned like any other skill. Julian Treasure does a beautiful job of laying it all out in less than 8 minutes: