How Doctors Can Improve Active Listening Skills

Physician active listening skills affect the patient experience and yours

One statistic on doctor-patient communication speaks volumes on doctors’ listening skills: Physicians on average give patients 11 seconds to explain reasons for his or her visit before interrupting the patient. This finding, as reported in the Journal of General Internal Medicine, can communicate several things, from What I say matters most to I’m not interested in listening to you. Neither is a good way to foster open communication.

The 11-second cutoff is one example of how doctors are often poor listeners. Let’s first look at why.

Time crunch from pay for volume & healthcare stakeholders

The medical system rewards seeing more patients, based on pay for volume, and not on providing quality care to our patients. The current pay for volume mentality prioritizes patients as cases to solve, influencing doctors to look at patients as organs (kidney, lungs, GI tract) rather than people with feelings, concerns and requesting solutions to their medical problems.

Instead, the doctor places a reliance on medications to deal with the symptoms rather than the time to investigate the cause and offer lifestyle changes that would improve the patient’s health. The best example is the obesity epidemic. If patients achieved their ideal BMI, that would make a large reduction in numbers of patients with diabetes, heart disease, hypertension, cancer and possibly Alzheimer’s disease.

Also, there is the problem of so many stakeholders (payers, hospitals and office managers\bean counters) to answer to. It is difficult for doctors to satisfy all the stakeholders.

With contemporary healthcare providers under so many time constraints, patients are unable to articulate their symptoms. When a time-crunched doctor doesn’t take the time to listen to the patient, it is no wonder that an ideal outcome is difficult to achieve.

Benefits of doctors being good listeners

Develop a friendly rapport with the patient and validate his or her concerns, which can be as simple as just nodding in agreement. Even this will help the patient to be more open and trusting.

Better decisions, patient satisfaction & online reviews

Listening will help you engage fully with your patients, make better decisions and ultimately provide better patient care.

My take home message here is that using your active listening skills with patients increases patient satisfaction and the physician’s online reputation as it leads to better online reviews. Your better listening skills will most likely enhance compliance, ultimately improve outcomes as well as reducing cost of care. Finally, effective listening to patients will certainly reduce malpractice claims.

5 keys to improving physicians’ active listening skills

What you are trying to achieve is active listening, a conscious effort to not just hear the words but understand the complete message your patient is communicating.

Observe verbal and nonverbal messages, don’t allow yourself to get distracted or bored, and provide feedback that indicates you have heard the message.

Concentrate on the patient only

Concentrating on the patient when he\she is speaking is not just a sign of respect, it is a vital aspect of understanding the medical situation at hand. Sit down without any barriers between the patient and the doctor.

And no multitasking. This includes the computer\EMR.

Practice mindful listening, not focusing on what you are going to say

Avoid trying to think of your next response instead of completely listening to the patient. Being focused on what you want to say is one reason for the 11-second cutoff the average doctor commits initially when he or she should be listening to the patient.

When a patient is speaking, concentrate on what he or she is saying – the specific words about the health condition and concerns.

To use a popular term, this is mindful listening: giving the person speaking to you your undivided attention every moment he or she is speaking.

You can’t do that if you’re thinking about what you are going to say after the patient finishes. You can figure that out in an instant – and with a more effective response – if you are fully listening to what the person is telling you. Both at the beginning of the conversation and to as great an extent as possible during the entire discussion, allow the patient to finish his or her thoughts before you jump in.

Eliminating distractions promotes active listening

Time constraints and pressures are often unavoidable, but they should not compromise your care and focus when you are in the exam room with the patient. Don’t use your cell phone or text another person when you are in the exam room with the patient. Do not read a chart or look at your computer, tablet or EMR.

Instead, be eyeball to eyeball with the patient. Also, I suggest that you sit down and not stand up with the patient on the exam table or sitting down, which puts the patient in a deferential position.

Instruct your staff to limit any distractions when you are face-to-face with the patient. For example, if the chart and exam room are well organized before you enter, you won’t have to search for information or supplies when you should be listening to the patient.

Mind your body language and nonverbal communication

Communication is more than what you say, it is how you say it. The tone of a person’s voice can often tell you more than his or her words. It may suggest that the person struggles with anger or depression, or it may point to a physical problem.

A patient with arms and legs crossed is usually considered to be in a defensive posture, so gentle responses on your part may ameliorate their defensive feelings. If the patient speaks quietly and looks down a lot, he or she may be displaying a reluctance to engage with you. Frequent smiling is a good sign that the patient is engaged and comfortable.

Ask if the patient has any more questions before ending

Finally, end every encounter by asking patients if all of their questions have been answered.

While you should be seeking their questions throughout the meeting, you don’t want them to leave without fully understanding their condition or your recommendations. Nor should you wait until your hand is on the door to leave the exam room before asking for remaining questions. This doesn’t leave a good feeling or a lasting impression with your patients if they see you have mentally shut down while they still have questions they would like to have answered.

Bottom line: As a medical student, we learned anatomy and physiology. As a resident, we learned how to diagnose and treat medical problems. Now, as a physician, we can and should learn to be better listeners.