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Sshhh – listen …………
The new GDC Standards state for the first time that we ‘must’ listen to our patients. As well as listening, we should be actively encouraging communication. Successful communication is the establishment of common ground between two people or an understanding. Specifically, the Standards say –
- You must discuss treatment options with patients and listen carefully to what they say. Give them the opportunity to have a discussion and to ask questions.
- You should be aware of how your tone of voice and body language might be perceived.
- Communicate effectively with patients – listen to them, give them time to consider information and take their individual views and communication needs into account.
- Give patients the information they need, in a way they can understand, so that they can make informed decisions.
People come to us with a story which is their history of clinical events and a whole lot more sometimes. We tell our story back, which is based on what we hope to do for them. Making those stories match is sometimes a challenge!
We can help people feel ‘heard’ through all sorts of techniques and one of the simplest is Active listening. This is a communication which requires the listener to feed back what they hear to the speaker, by way of re-stating or paraphrasing what they have heard in their own words, to confirm what they have heard and moreover, to confirm the understanding of both parties.
When interacting, people often "wait to speak" rather than listening attentively. They might also be distracted. Active listening is a structured way of listening and responding to others, focusing attention on the "function" of communicating objectively. This also includes "interpreting body language" or focusing on something other than actual words. Dialogue, understanding and progress can only arise from finding common ground. And that common ground cannot be established without respect for the words as spoken by the patient. Further, this is about having respect for the patient themselves.
Thus the essence of active listening is as simple as it is effective: paraphrasing the speakers words back to them as a question. This leaves little room for mis-interpretation. It is functional, mechanical and leaves little doubt as to what is meant by what is said. "The process is successful if the person receiving the information gives feedback which shows understanding for meaning. Suspending one's own frame of reference, suspending judgment and avoiding other internal mental activities are important to fully attend to the speaker. It helps to avoid distractions when you know that you intend to work like this.
Showing the patient that you are really listening to what they are saying is part of building ‘rapport’. Patients who feel this are more likely to take on good-health messages, or opt for more sophisticated treatments. This is because they feel they are dealing with someone with whom they share similar values, beliefs, knowledge, or behaviors. Find out more about their interests such as sport or music and show an interest in it. Rapport occurs when two or more people feel that they are in sync or on the same wavelength because they feel similar or relate well to each other. Rapport is theorized to include three behavioral components: mutual attention, mutual positivity, and coordination.
There are a number of techniques that are supposed to be beneficial in building rapport such as matching your body language (lean the same way as they do), maintaining eye contact and matching breathing rhythm.
The principles of NLP say that people are divided into different types, those that are aware of the world in different ways. For instance, if someone says “I can’t see any way out of this” they see the world as a visual environment. If we answer with “Let’s look for an answer” it will be more meaningful and communication will be better.
It’s also a fact that people belong to different personality types. Some require direct evidence of intentions, some require a long detailed explanation and some will not wish to know. Clues are in their story and the way they tell you things. If you try to give a Type A person a long convoluted explanation of treatment they will just switch off. Get it wrong at your peril!
Listen to their ‘story’
Everyone comes with their own narrative based on their personal beliefs. These beliefs may be cultural, or religious, or just handed down within families. From the time they enter the surgery they will be laying out their story, and the way they tell it will give clues as to what they believe. If the story doesn’t make sense, it is important not to challenge this directly, but to fully listen and pay respect to what they have to say. The histories, signs and symptoms they will be telling you about are the ones that are important to them and the ones that make sense to them. However, they may not be the issues you would give priority to. Listen first and then show them that you have heard by reflecting back what you think they have said.
When you ‘reframe’ their story you have the chance to say it back in different words, but words that make more sense to you. Using this technique, you can begin to match your beliefs with theirs.
Most people will initially be after reassurance that all is good, or after pain relief if it’s not. Keep the response in line with this. As you gain their confidence and trust you can expand the story into new areas, such as marketing the treatments you are interested in. As with any good novel, build up the picture first.
It’s the way you tell’em
At this point, you need to work your own narrative in a way that can be understood and is parallel, not in conflict, with theirs. However, that’s another story!
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