Listening in Medicine

The word ‘listen’ is an anagram for the word ‘silent’.  Silence is fundamental to effective listening; there needs to be stillness in your heart and mind when you listen to another.  In the words of the late and beloved John O’Donohue “Listening is an act of worship.”  When we listen to another we need to be attentive not only with our heart and head, but also with our ears, eyes and touch.  Lack of eye contact, fleeting eye contact, whispering or tentative or aggressive tone of voice, stiff or limp response to an outstretched hand, depressed or anxious facial expression, skin pallor, uptight standing or sitting posture, shortness or sudden intake of breath add considerable impact to the words a person speaks.

When it comes to a doctor or medical consultant or, indeed, any health care professional, listening to a person’s narrative of their illness and troubled state of heart and mind is a vital issue.  Regrettably, according to Michael Livingston, family doctor and author of Listening in Medicine: “generally, current medical teaching neglects the importance of listening to patients.  Students suffer from much neglect and their patients suffer later”.  Livingston asserts that “patients’ tales or narratives are essential to understanding medicine and health care”.   

The tragedy is that in today’s hit-and-run managed care medical consultation, the art of listening has been replaced by the art of moving the patient on as quickly as possible.  Whether medical practitioners will be motivated to recover the art of listening is highly debatable!  However, whether today or yesterday, many people’s medical conditions spring from psychosocial causes and,indeed, have deep psychosocial intentions that go beyond the physical cures that medicine offers.  No matter what the source or the different intentions of a particular illness, active listening is critical to its resolution.  Some critics argue that listening to individuals who seek out their care takes too much time.  However, there is considerable clinical and research evidence that listening saves both time and resources.  Nevertheless, in spite of the latter, research shows that doctors listen for an average of eighteen seconds before they interrupt the person’s narrative of their symptoms!  There is no doubt that medical technology has achieved so much but the person-centred interview cannot be matched by technology or self-report inventories.

It needs to be acknowledged that when a medical doctor suggests psychosocial reasons for presenting physical symptoms he may well encounter patient hostility, as it is still prevalent in our Western culture that psychological illness is perceived as stigmatising.  However, it is a fact that medicine treats all illnesses as having physical causes, even though it accepts the reality of the high prevalence of psychophysiological illnesses and that, indeed, all illnesses are psychosomatic in nature.  In relation to the last point, the psychological response to an illness can often have more serious consequences than the physical cause.  There is no doubt that doctors live with the fear they might miss something.  That something is commonly assumed to be a hidden physical problem.  However, ironically, doctors rarely fear missing psychosocial problems which may affect individuals just as much and, sometimes, even more than physical illness.  Due to the nature of their training and

 identity being tied up with being the expert, medical doctors are more comfortable in diagnosing and managing physical conditions.  The latter often results in individuals being shuttled from one specialist consultant to another with no consultant taking overall responsibility.  When doctors and consultants operate in such blinkered ways, ironically, they require help and support to examine the hidden psychosocial reasons that underpin their behaviour.  There is no intention on their part to neglect those in their care but, like the rest of us, lay and professional alike, unconsciously they carry emotional baggage into their living and professional practicing.  It always puzzles me that frontline professionals – medical doctors, medical consultants, parents, teachers, political and community leaders and heads of work organisations, are not required to undergo ongoing examination of their unconscious processes that can have a powerful impact on the lives of others.

Narrative in medicine needs to be valued and there needs to be a shift from what is a predominant bio-medical to a biopsychosocial model, incorporating psychosocial factors to fully encompass the causes, intentions and reactions to illness; indeed, spirituality also deserves consideration.  The new model needs to emphasise too the personal development of medical practitioners as personal effectiveness is the basis for professional effectiveness.  Unless a medical practitioner learns to actively listen to self, he is unlikely to be in a place to receive, rather than take, a full holistic history from the person presenting with an illness

Dr. Tony Humphreys is a Consultant Clinical Psychologist, Author and National and International Speaker.  His book with co-author Dr. Helen Ruddle The Compassionate Intentions of Illness is relevant to today’s column.