the art of listening

judge

Please hear what I’m not saying:  the art of listening in the clinical encounter is one of the most important articles that I’ve read in a long time.  It was written by Mary T. Shannon, a social worker, and was published in The Permanente in 2011, a medical journal with a focus on medicine and the humanities.  In the awesomeness that is Twitter, this article was recently tweeted by Isabel Jordan, founder of the Rare Disease Foundation, and before that, shared by Marie Ennis-O’Connor, a health blogger in Ireland. Twitter is my best curator of the Internet.

Please hear what I’m not saying has had a profound effect on me.  I’ve shared it widely with my colleagues in the health world.  It inspired me to buy the book The Spirit Catches You and You Fall Down by Anne Fadiman, which is actually a brilliant analysis of the vast cultural differences between patients & families and health professionals.  I’m planning on writing more about The Spirit Catches You, but in the meantime, here is an important quote about it in Shannon’s article:

“…the author tells the story of a Hmong patient who was being referred to a specialist for further treatment and, instead of inquiring about the physician’s skill or credentials, he asked, “Do you know someone who would care for me and love me?”

The article continues to eloquently express so many topics that are dear to me:  the hierarchies in the health system, the professionalism that clinicians hide behind, the breaking of trust between patients and clinicians, the deep-rooted need for compassion and the basic human desire to be listened to.  I can’t do this article justice – please just click on the link and read it for yourself.

There are so many pieces of Please hear what I’m not saying that speak deeply to me about the art of listening.  I’m struck with how many ‘complaints’ in the health system are not actually complaints at all.  Most times they are constructive feedback that is disguised as a ‘complaint’ – feedback that is actually valid suggestions that can be used to improve the quality of an experience in a hospital environment.  That is, if the ‘complaint’ is listened to by staff in a value-neutral way, with this positive lens:  complaints are not negative.  They are merely constructive feedback that staff can reflect upon to improve care and service.  There are always good reasons behind a ‘complaint.’

I’m more interested in that WHY behind a ‘complaint’.  The why often sits in pain or fear, and many times it stems from broken trust between the patient/family and a health professional.  This erosion of trust may have been due to an experience that even happened many years ago (sometimes beginning right when a diagnosis or news is disclosed and the journey in health care begins), but patients/families carry the burden of these experiences around with them.  It is up to every subsequent health professional to help to mend that broken relationship and build that trust again in health care in partnership with the patient & family.

What is almost universal, and hides in the subtlety of patient stories, is a theme of not feeling heard or listened to.  Please hear what I’m not saying validates my strong belief that the way to honour patients and families and to help them heal is to listen to their story in a respectful way – through active listening.  It is through this listening that health professionals can demonstrate they care and help mend that broken trust.  As Mary T. Shannon carefully points out, every person desires to be cared for and loved.  As I say, people will care for themselves if they themselves feel cared for.  This is a very powerful notion, and it sits at the very core of the care in health care.

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