Advice from a Patient Advocate: Active Listening 101
"There is a difference between listening and waiting for your turn to speak." (Simon Sinek)
A relative of mine is entering hospice today. Yesterday, I spent the whole day at the hospital and assisted he and his wife to select a hospice provider. This involved very honest and difficult conversations about dying - never an easy task. As I participated in meetings with the palliative care doctor, case manager, patient chaplain, and the hospice, I felt extremely grateful for my training in "active listening". During these meetings, I kept making mental notes about best practices when communicating with patients and their loved ones (which in this case, I was also one).
Here are five simple techniques that I put into practice yesterday:
Eye Contact: For most of my life, I have found it hard to make eye contact. Eye contact is so incredibly powerful that it actually makes me uncomfortable. But when talking to patients, family and caregivers, it can't be avoided. It is essential to building trust and expressing empathy. For me, I had to remind myself constantly to look into the eyes and not at the bridge of the nose.
Repetition: Very often, we try to verify that the person you are talking to understands what it is that you are saying. It usually sounds like this: "Do you understand?" Unfortunately, it is all too easy for the patient to simply say "Yes." Yet, that does not necessarily mean that they did, in fact, understand what was being said. A much better way to ensure comprehension is to ask the patient to repeat back what they heard. No matter how brief the repetition is, this is the only way to know for certain if the patient is properly receiving the information. (For people with memory issues, this process may need to be repeated several times.)
Wait: Another life-long communication issue that I have wrestled with is interrupting people when they talk. I don't know if it's a result of being a middle-child raised in New York or not. I want to get my two cents in so badly or I fear that I will forget what I want to say that I regularly talk over other people without waiting for a pause. While this may be an acceptable practice on political discussion panels, it is not in a clinical setting. I have to consciously curb this behavior all the time. Yesterday, I kept telling myself to be patient and wait until others were done talking. It was like a constant mantra playing in my head. I lost track of how many times I reminded myself to do this. :)
Non-Verbal Cues: A lot goes on while you are listening. You may be taking notes, trying to remember what is being said, or thinking of questions to ask. It is easy to get distracted and not perceive the volume of non-verbal communication occurring. Over the past several years, I had a lot of practice developing my non-verbal perception skills because of my wife's recovery from brain surgery. She can easily get overloaded with stimuli and then start to "phase out." I have become an expert at recognizing the early stages of this and remind her to take a break. It is almost a sixth sense. In reality, it is simply recognizing the non-verbal cues which are often found in her eyes (see #1 above). Patients often have trouble being self-aware of their confusion or lack of comprehension. It is also very common for people to feel self-conscious about their lack of understanding (especially when English is their second language). To ensure effective communication, it is very important to always be looking for the non-verbal clues (of which there are many).
Summarize: This is very similar to Repetition except that it involves the advocate doing the repeating. It generally takes the form of: "So, what I am hearing is..." This works extremely well when speaking with patients, doctors, family or anyone in the clinical setting. Not only does this verify your understanding of the conversation, repetition helps all the participants to retain the information being conveyed.
Active Listening skills may come easier to some than others. For me, it is very hard. It requires a lot of conscious effort. Yet, it is so valuable. I consider this to be part of not only my professional growth but my personal growth as well.