Listen up: It's a Practice Builder

I'm posting this article which appeared in the magazine "Medical Economics" which provides physicians with information on the business aspect of medicine. I hope many more doctors take the time to read this article; it has many helpful tips. I'm glad I have learned some of this in the BEGINNING of my medical career versus 10 years later.



The physician who really hears what his patients are saying may wind up learning a lot more than he expects.
Dec 3, 2004
By: Barry Bub, MD

To be a good listener
A rush through the cafeteria, a stampede of stressed-out doctors and students to the conference room—I took in the scene with relief. An hour earlier I had been asked to give a talk on stress, and now I knew what to do. Nothing.

As everyone was eating and socializing, the behavioral psychologist coordinating the event signaled me to begin. I shook my head. Ten minutes later, the chief resident looked up from his plate and inquired, "Aren't we having a talk today?"

"I thought I would give you time to eat in peace," I explained.
"I can chew and listen at the same time," he shot back.
"What do I do now?" I thought. This experiment has failed.

Just then his brow furrowed, the smirk replaced by a frown. "You know, my father was an internist. He rushed in late for meals, grabbed something to eat, and was off on some errand. He was always doing two things at once and I was 14 before he remembered my birthday. Are you trying to teach us something?"

Indeed I was.
By allowing the participants to chat and eat without stress, I offered them a contrast to their normal hectic, multitasking day. Perhaps this might yield some insight.

I wanted to draw a parallel between my effort to speak to physicians who were eating lunch, and patients trying to communicate with physicians distracted by practice issues.
As a presenter, I prefer 20 minutes of undivided attention to 50 minutes of partial listening. "Could it be," I asked the group, "that patients are really asking for just a few minutes of attentive listening?"

I had good reason to ask. As a goal-oriented family physician, I had rushed my way through 30 years of practice. I was successful financially, but distressed by patients who inexplicably left my practice, employees who quit suddenly, and personal relationships that dissolved despite my best intentions. Dissatisfied, I retrained in Gestalt psychotherapy and chaplaincy and found new dimensions in communication and awareness. Many profound concepts emerged as I unlearned the myths about listening which I was taught as a medical student. Now, I mentor physicians on communication and self care skills.

The following are some listening myths that continue in the medical environment:

Listening is a luxury.
In other words, if there isn't enough time, you can skip listening. Sure, but only at your peril. Not only do you run the risk of missing clinically significant anxiety and depression, you invite patient dissatisfaction and anger—a frequent trigger for litigation. Consider, too, the impact on your well-being when you are deprived of the benefits of positive feedback from patients and others.

Listening is intuitive.
On the contrary, much about listening is counterintuitive—particularly to physicians accustomed to interrupting and attempting to fix problems. Listening professionally, trying to connect with underlying emotions rather than just words, is a highly complex task, one that is both therapeutic and diagnostic. It requires training and practice.

Listening is an auditory experience.
Since so much communication is nonverbal—expressed through body language, facial expression, and eye contact, all of your senses are utilized as you search for clues. This is an important concept since words are often used to obscure and defend against painful feelings. You may miss a great deal of what your patient is communicating if you concentrate solely on your patient's speech.

Listening is passive.
Gathering clues, processing information, deciding when and how to respond to the patient are all actions. Sometimes a silent, supportive presence is the most appropriate active response to a patient's painful situation.

Listening can be done without a break.
There is a reason why psychotherapists work a 50-minute hour. It takes a few minutes to ground yourself, assimilate information, and create a transition between patients. As a physician, you will be a more effective listener if you pause for a few seconds to catch your breath between patients.

Listening is compatible with multitasking.
Listening is hearing with attention. Simultaneous actions such as eating lunch, checking mail, and listening on the phone are an all too common experience for the physician trying to be efficient. But when your attention is split between two or more complex tasks, both are likely to suffer. Time is wasted and important details are missed.

There is no time for listening.
The expectation that patients want lengthy listening is based on perception rather than fact. Often all that is wanted is a minute or two of undivided attention. For the pressured physician, this feels much longer than it really is. In reality, most patients tend to be considerate of their doctor's time. Your listening is facilitated when you create a calm, orderly, efficient environment. Doing this will help you shave away minutes from each visit without reducing quality of care. Think of the time saved when you have satisfied patients, staff, and spouse.

Listening is expensive.
Certainly, with attentive listening there is an investment of time that is usually not reimbursed. With overhead high, listening feels like money wasted. When viewed in the context of your practice, the benefit of having a thriving practice of satisfied patients who feel heard and understood makes careful listening a profitable investment. Certainly, there can be no better free advertisement than a patient who says, "You'll love my doctor, she listens, she cares."

Listening is done for the benefit of the patient.
There is a pervasive myth that listening is initiated by compassion. In reality, it is an integral part of good medical practice. Compassion might emerge as you understand your patient's situation, but it is not the principal reason to listen. If anything, you stand to benefit more from a growing practice, reduced risk of litigation, and enhanced personal well-being. In short, listening is not only possible, it's great for business.