I don’t think we studied “listening skills” at college, and I’ve never been on a course specifically addressed to this, but I never thought that mattered because I thought I was pretty good at it. Always interested in a patient’s life, always letting them talk and murmuring encouragement and validation; I thought I had it pretty sussed. But on a course last week I was surprised to find that I might not be as good as I thought. I was reminded of a 20 year old celebrity on Hell’s Kitchen who confessed “I always thought I was good at cooking, but now I realise I was just heating things up.” Yes, and I learnt that being interested in patients’ lives is not the same thing as being a good listener.
We began with a quote from Lao-Tsu:
It is as though he listened, and such listening as his enfolded us in a silence in which at last we begin to hear what we are meant to be
OK, well, that’s aiming quite high. I’m certainly not Lao-Tsu. I don’t really expect to facilitate an enlightened self-actualization in every treatment, and neither do I want to be a counsellor or psychotherapist. The line between listening and counselling is not always clear, and patients can treat us like counsellors even if we don’t want that role. The early days when I felt flattered when patients confided their life experiences to me are long gone. Now I see it as a privilege, but an enormous responsibility and a potential minefield. I don’t want to make things worse with a crass or inapproriate comment. And I’m sure I have done this in the past, through being ill-equipped, naive and out of my depth. My aim is simply to be a caring and attentive presence, in an effort to understand the patient and their needs. To be even more pedantically accurate, in an effort to help the patient understand themselves and their needs.
So, patients talk to us. And we talk to them. And this is very valuable therapeutically. The amount of time we spend with patients gives us enviable opportunities not available to all health care professionals. And this is not to be squandered. So here are a few tips based on what I learnt on this course. They might seem obvious but I got a shock when I realised how much better my listening could be.
Establish eye contact
Sit with an open and relaxed attitude and look at the patient, especially at the start. Be receptive. I had a GP once who was very unpopular. But the primary complaint that everyone made was that instead of looking at you she was looking at her computer. It felt rude; not efficient or thorough.
I’m dreadful for this: impatiently finishing people’s sentences with the wrong word, presuming I knew what they were going to say; only realising after a conversation that I missed hearing something interesting because I was so determined to butt in with my own story. I don’t think I do this as much with patients, because in the alchemy of the treatment room no patient ever seems boring. But I do do it. Bear in mind too it can be wrong even to interrupt silence – unless you want to say something, or unless it is truly awkward, try to regard this as “thinking time” for the patient, where something they might want to say is emerging.
Give no opinions or advice; do not be biassed or prejudiced
This was a piece of advice given to us on a biodynamics course. I didn’t think I gave opinions at all. Then I paid attention and noticed I did it all the time. Opinions about the best way to treat a patient’s condition are appropriate, and indeed what they pay us for. But then one can venture into opinions about the NHS, about doctors, about acupuncturists, physios (OK at least these are in my field and maybe patients appreciate my insights) but more dangerously you can get into advice about dealing with relationships, career, how to bring up children, whether Britain should leave the EU and so on. This kind of thing can backfire and is not always appreciated by patients. I suppose it is sometimes appropriate if you are directly asked, but unsolicited advice or opinion on anything other than direct therapeutic advice is a no no. I don’t think anyone is free of prejudice or bias, but we can try to reflect on our own particular prejudices and how we are reacting to what the patient says. If we are getting angry or judgemental we should be well aware of that.
Don’t ask inappropriate questions which seek to satisfy your own curiosity, more than understand the client
Guilty, guilty, guilty. If only people weren’t just so darned interesting. This is something I have to struggle with the entire time.
Don’t tell anecdotes of similar experience
Now this was the advice given by the listening expert, but I admit I am conflicted about this. I see sharing stories as an empathic and helpful thing to do. If I am in a pickle, or a bad place, knowng someone else has been there can make me feel supported, understood and less isolated. And finding out how they resolved a problem can be helpful to me too. But the danger is you can get distracted by your own experience, and maybe forget that you are trying to provide a therapeutic situation. It can degenerate into you chatting or getting yoru own counselling from the patient!
Listening is not the same as having a social chit chat
Yes, often I am just chatting with a patient. We might cover a comparison of our holidays in Italy, what they thought of the Welsh woman on Britain’s Got Talent, the virtues of ALDI compared to LIDL, the difficulty in finding a decent plasterer – I could (and do) go on, and on, and on. Is that OK? Not every patient wants to unburden themselves or delve deep into the meaning of their symptoms. And you need a little small talk to oil the wheels of the communication. And the chatting helps the bonding of the therapeutic relationship maybe. But it can just turn into chatting, pure and simple. Is that OK if it doesn’t distract you from treatment? Is it really helpful, is it what the patient needs, is it using your time to its full potential, does it ruin the therapeutic relationship? Maybe, if someone is starved of company or like minds, this is what they need. But we need to have to have that question in our minds.
So, like so many things in osteopathy, the best thing we can do to improve our skills is a higher level of attention, not least towards ouselves.
Edited 13/5/16 – due to internet server being down in previous week and blog being published in unpolished form