— PERSONAL + CAREER DEVELOPMENT —

Active Listening Not Just Hearing

Dr. Raj DK Dhaliwal
Dentist, Dento-Legal Advisor and Contributing Author

“Previously I have emphasised the importance of first impressions when greeting our patients and also the significance that the environment can play in respect to promoting patient-centred care. Now, I will continue this series of articles with perhaps the most crucial element of the appointment, the diagnosis itself. In this third article, I would like to address the act of listening. This skill is more than just obtaining patient information; if done well the listener will also demonstrate empathy and ensure that the patient and the patient’s health agenda remain central to the clinical consultation.”

Active listening

Steven Covey in his critically acclaimed book,  ‘The 7 Habits of Highly Effective People’ concludes that “most people do not listen with the intent to understand; they listen with the intent to reply.”1 

Unfortunately, this can be true for many health care professionals.  Studies indicate that during a consultation a patient may be interrupted after a mere sixteen seconds of asking a question.2 As well as being impolite, abrupt disruption means we are ineffective in fully comprehending the patient’s concerns and how these concerns affect their daily life.  

Interrupting the patient early on in a conversation can lead to a practitioner failing to obtain insight into a patient’s psychosocial context, their treatment needs and expectations.3 It is important to appreciate a patient’s specific concerns rather than shoe-horning their issue to provide an immediate and generic response; after all no two patients are exactly the same whether that be due to differences in culture, life experiences, gender or age.

Having established that active listening is an important component of patient centred care.  How can we ensure that we most effectively listen to our patients?

Opening a consultation

Beginning the consultation with an open ended question such as “ How can I help you?” focuses both the clinician and the patient on the consultation and allows the patient to inform you, as their treating practitioner, of their needs. It also gives the patient time and freedom to air their expectations.

Non-verbal cues

When listening, listen for the content of the conversation as well as the feelings of the speaker and look out for the non -verbal cues. This can be difficult; as clinicians we are always looking for signs and symptoms and trying to evaluate the treatment the patient may need, by picking up key words.

Whilst the patient is speaking encourage them and signify that you are listening, as discussed in my previous article, using non-verbal cues such as head-nodding and eye contact.  Give them your undivided attention by not making notes or looking up their previous records. At this stage of the consultation only give minimal verbal encouragers such as “Ah, I see”, “I understand”, “Of course.”  

Review the conversation

As the consultation progresses start to paraphrase the content of the conversation to ensure and convey understanding of the patient’s concerns and needs and also to convey this understanding to the patient.  Phrases such as “let me see that I understood everything correctly” or “If I may summarise what you have told me so far.”  This phase needs to be non-judgemental and will encourage the patient to provide further information.  It is also an important aspect of the history taking as it allows both parties, the patient and the clinician, the time to reflect and start moving towards a patient centred treatment plan.

The final phase of this interaction is asking specific questions.  This is when one needs to exercise care and not undo all the good work of active listening, by then reverting back to our “undergraduate” taught list of questions.  Yes, these questions do need to be answered but care needs to be taken that the patient did not provide the information in the initial phase of the consultation.  It can be very disheartening for a patient if they are then asked a serious of “standard” questions when they have already provided the responses.

Being in the moment

Mindfulness, a current buzz word, is in its simplest form, being in the moment. The individual focuses all their attention on the present, experiencing thoughts, feelings and sensations but without judgement. If as clinicians we adopt such a technique and really focus in on the consultation rather than letting our minds run away to the potential treatment plans or how late the clinic is running or the state of our inboxes, we are laying the foundation towards a patient centred treatment plan.  More so it may enable the patient to mirror us and so also adopt the same technique allowing them to focus solely on their treatment needs and wants. 

Will it increase the consultation time?

You may believe that this patient centred method of undertaking your consultation may be time consuming.  It is important to remember that taking this time to build up a rapport not only increases patient satisfaction, but in turn, as we previously discussed, leads to a reduction in the number of complaints.  This approach also ensures that the patient’s treatment needs are met and so will lead to a decrease in the treatment time as the correct treatment plan will be established from the outset.

1 Covey S: The 7 Habits of Highly Effective People 2013 (p250)

2  Dyche L, Swiderski D. The effect of physician solicitation approaches on ability to identify patient concerns, J Gen Intern Med. 2005;20 (3) 267-270

3 Epstein RM, Franks P, Discella K, et al. Measuring patient-centred communication in patient-physician consultations; theoretical and practical issues. Soc Sci Med. 2005;61(7): 1516-1528

DR. RAJ DK DHALIWAL

After graduating from the University of Birmingham Dental School, England, Dr. Raj DK Dhaliwal BDS LLM MDentSci MRACDS(DPH) MFGDPRCS MAICD undertook research into dental public health, published and presented this research in the UK and internationally and completed a Masters in Dental Science. Raj worked for many years in general dental practice in both inner city and suburban practices.

In 2013, she was awarded an LLM in Healthcare Ethics and Law with Merit from Manchester University. Raj developed her interest in care quality, clinical negligence, consent and confidentiality.

Raj has worked as a dental practice advisor to NHS England and works as a dento-legal advisor both in the UK and more recently in Australia. Since immigrating to Australia she also acts as an examiner for the Australian Dental Council and the Royal Australasian College of Dental Surgeons.

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