Communication StudyThe importance of physician listening from the patients’ perspective: Enhancing diagnosis, healing, and the doctor–patient relationship
Introduction
Listening is a complex and vital feature of clinical practice for physicians. Despite attention paid to teaching and evaluating listening in clinical education [1], [2], [3] and practice [4], [5], [6], [7], [8], [9], [10], [11], very little has been published on physician listening from the patient's perspective. Elucidating this perspective contributes to the literature and provides empirical evidence on the role and function of listening for medical education.
While ‘listening to the patient’ has been increasingly accepted as integral to good medical care, two shifts in healthcare over the past few decades provide compelling arguments for understanding its role and function. First is the shift in disease prevalence from acute, infectious and single organ diseases to chronic, complex and often degenerative or incurable conditions [12]. Second is the increased complexity of healthcare service delivery due to progress in medical science and technology [13]. Given these shifts, it is important to understand why physician listening is important and how it may contribute to clinical outcomes and patient satisfaction.
Enhancing communication skills training has been seen to improve health outcomes [14]. A notable benefit is that attentive listening early on in the patient interaction is associated with a greater likelihood that all of the patients’ complaints or issues will be revealed; in other words, there is a reduction in so-called ‘late-arising concerns’ during the encounter [15]. However, physician listening may have benefits far beyond accurate reception, reporting, and recording of patient complaints. Our data demonstrate an expanded range of reasons why physician listening is important.
The International Listening Association defines listening as ‘the process of receiving, constructing meaning from, and responding to spoken and/or non-verbal messages’ [16]. Despite the consensus on the importance of listening as a critical element in communication skills, surprisingly little attention has been paid to its definitions in clinical settings and its putative roles in patient care. One of the challenges is the fact that constructing meaning from and responding to patients is a highly subjective endeavour, presenting challenges for measuring and evaluating listening skills. Evaluation is challenging because the act of listening is subjective, abstract, subtle, and internal. In addition, educational models of clinical listening distinguish between active and passive modes. Passive listening, in which the physician quietly listens but without necessarily engaging with the patient to address their concerns, can be seen as problematic. ‘Active listening’ [17] and ‘attentive listening’ [18] on the other hand are emphasized in medical training. For example, the Calgary-Cambridge guide to communication skills outlines four areas where active listening may have a beneficial impact. These include (a) wait time; (b) facilitative response; (c) non-verbal skills; and (d) picking up verbal and non-verbal cues [1]. Missing from this and other similar models however, is description of the functions of listening from a patient perspective. This article is focussed on that critical perspective
In 2005, the undergraduate medical school curriculum at McGill University was reorganized and oriented to address “physicianship”: the explicit teaching of the physician's two roles as healer and professional, founded on the belief that the primary mandate of medicine is healing and the relief of suffering [18]. In tandem with curricular renewal, patients were consulted on the reform initiatives to guide curricular development. The overall findings of the study have been published elsewhere [19]. The findings presented in this article are a subset of the data from that study in which patients were asked to convey their attitudes, perceptions, thoughts, and feelings about their experiences with physician care.
Section snippets
Method
The study used an interpretive description (ID) design [20]. ID falls within a constructivist paradigm which assumes that all knowledge is partial and subjective, and that research data are co-constructed by the participant and the researcher. We used ID based on the idea that patients’ subjective experiences are a valid and essential location for health care research inquiry, given the belief that change to applied clinical disciplines should come from engaged dialogue with the relevant
Results
Three sub-themes help to capture the reasons why and how physician listening was important to patients (see Fig. 1). Listening was perceived as fulfilling three functions: (a) as essential for appropriate clinical data gathering, diagnosis, and choice of therapeutic interventions; (b) as a healing and therapeutic agent; and (c) as a means of fostering and strengthening the doctor–patient relationship.
- (a)
Listening as essential for appropriate clinical data gathering, diagnosis, and choice of
Discussion
Our research reinforces a common belief within and outside the medical community that physicians who demonstrate attentive and respectful listening reinforce the healing process and may contribute to improved clinical outcomes. It is congruent with the literature on the positive impact of listening on patient satisfaction [23], [24], [25] and patient disclosure of problems and emotional content. Davidsen's [26] study found that physicians’ listening signaled a ‘general giving of permission’ for
Acknowledgments
This project was supported by grants from the Montreal General Hospital Foundation and the Max Bell Foundation. Author JDB is grateful for financial support from the Arnold P. Gold Foundation.
References (26)
- et al.
Active listening in medical consultations: development of the Active Listening Observation Scale (ALOS global)
Patient Educ Couns
(2007) - et al.
Patient and physician perceptions of their relationship and patient satisfaction: a study of chronic disease management
Patient Educ Couns
(1993) Exploring information-exchange in consultation: the patients’ view of performance and outcomes
Patient Educ Couns
(1995)- et al.
Doctor–patient communication: a review of the literature
Soc Sci Med
(1995) Experiences of carrying out talking therapy in general practice: a qualitative interview study
Patient Educ Couns
(2008)- et al.
Skills for communicating with patients
(2005) - et al.
Preparing medical students to become attentive listeners
Med Teach
(2009) The significance of listening and conversation in the doctor patient relationship
Zuhoren und fragen – Bedeutung des arztlichen Gesprachs fur das Arzt-Patienten-Verhaltnis Verdauungskrankheiten
(1997)The doctor–patient relationship II: not listening
Medscape J Med
(2008)The doctor–patient relationship III: a way of listening – the balint group revisited
Medscape J Med
(2009)
Listening, talking, relating: the state of the art and science of the doctor–patient relationship in family medicine education
Fam Med
Doctor–patient communication and the quality of care in general practice
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