By Kelva Edmunds-Waller, DNP, RN, CCM
A good conversation with someone who knows you can lighten your mood, lessen worries, and encourage and comfort you. Laughter from a good interaction is food for the soul. These interactions involve great conversations that start with a great listener. In healthcare, therapeutic interactions go beyond the communication skills commonly taught. Active listening skills are not enough when it involves communicating with patients. Everything from not interrupting, using facial expressions and head nodding to show interest and expressing verbal cues like the occasional “mm-hmm” are not enough. Patients are known as “speakers” and strangers, or barely acquaintances, to healthcare workers, who are known as “listeners” in this environment. As “speakers,” patients need the space between them and the “listener” to feel safe enough to communicate openly and honestly. The speaker wants to be acknowledged, heard, and seen as an active participant in decisions about the care they receive.
Silence is not golden between patients and healthcare providers. A great listener creates a safe and non-judgmental space that fosters open conversations, contrary to conversations that result in sitting quietly and nodding. When a speaker feels at ease, they have greater confidence to share their thoughts and questions candidly and openly. A great listener reads non-verbal communication: stoicism, perspiration, handwringing, toe-tapping, and posture that may show mistrust or a speaker’s emotional state. The listener can then acknowledge the speaker’s emotions with genuine empathy.
To intentionally focus on the speaker, a great listener eliminates distractions which sends a message to the speaker that they are significant and their questions and concerns matter. The listener does not monopolize the conversation. A great listener asks clarifying questions to gain insight into the speaker’s needs, thoughts, and understanding of a healthcare concern. Asking questions allows the listener to confirm what the speaker is saying without making assumptions. Questions create a two-way dialogue that engages both parties and builds trust and cooperation as communication flows back and forth between both parties. Finally, great listeners make suggestions. The suggestions are not prescriptive. Instead, these suggestions create an opportunity for the speaker and listener to explore different ways to frame or view an issue or concern and discuss options for management.
Listening occurs at varying levels, requiring different degrees of focus and attention by the listener. A great listener recognizes verbal and non-verbal signals from the speaker and adjusts their listening skills to match the speaker’s needs and the situation. Healthcare providers need skills that go beyond active listening to communicate more effectively with speakers and caregivers. Improved care quality, patient safety, better health outcomes, and trusting relationships are products of great listening and less talking. The following real-life scenario illustrates a great conversation with a great listener:
One of my dear friends recently had a mammogram “scare.” Over 3 weeks, a routine mammogram screening turned into a diagnostic screening which turned into a breast biopsy due to a finding of “atypia” or atypical cells found on a mammogram. The primary care physician communicated by phone that the atypical cells did not show a malignancy but referred my friend to a breast surgeon for further follow-up. Instead of the biopsy results appearing in the patient portal, the pathology report arrived by mail. You can imagine the nagging worry that occurred from screening to biopsy. The worrying intensified after receiving the pathology report.
Two weeks later, my friend met with the office staff and the breast surgeon. During her check-in, the clinic nurse asked, “What do we need to know about you to help us serve you better and make you comfortable?” This question took my friend by surprise. She replied, “I want to be heard, listened to, be a part of decision-making, and have a collaborative relationship.” She also shared that she wanted to be respected and receive equal treatment. As a Black woman, my friend has seen up close and personal the disparate treatment, health disparities, and health inequities for people of color. Recalling the encounter, my friend said, “I didn’t want to be treated differently or receive inferior care because I was being judged based on the color of my skin.”
After introductions, the surgeon took a seat and acknowledged that the last few weeks had been stressful. Then she said, “So, let’s start with you. What questions do you have?” Of course, my friend needed assurance that the atypical cells were not malignant or precancerous. The surgeon assured her that they were not. She explained atypical cells and the pathology report in a simplistically, and she also explained the imaging to support the biopsy interpretation.
When the healthcare provider discussed treatment options, my friend said, “I felt like a partner in the discussion. I think she recognized that I had done my research. But even if I hadn’t, I don’t think she would have treated me differently.” During the breast exam, the provider explained the importance of breast aesthetics and commented on the scarring from the tape used during the breast biopsy. My friend said, “It may have been a small thing, but I felt like she saw me as a whole person.”
When my friend left the office, she had an appointment to remove the benign breast tissue. She also had a picture showing the location of the atypical cells and what the cells looked like. The provider shared all the procedure details and supplied literature to review. It was an impressive encounter for my friend. The provider made her feel comfortable to be vulnerable about her body. She didn’t rush her to move on to her next patient. She responded to questions thoroughly and thoughtfully. This was a great conversation for my friend because it began with a great listener.
Most healthcare workers believe they are good listeners. But how often have you walked away from a personal encounter with a healthcare worker with unanswered questions, an unaddressed concern or worry, or felt that you were only allowed to listen but not speak? Healthcare consumers are much savvier than they were decades ago. They have access to more health information, and they have more choices. Being a great listener is consequential for the speaker and the listener (or the patient and the caregiver.) So, are you a great listener? Find out by checking out one of the websites below that offer a free inventory assessment:
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Bio Kelva Edmunds-Waller, DNP, RN, CCM, is a case manager in general internal medicine. Her clinical experience includes home health, public health, managed care, home infusion, health education, and healthcare administration. Kelva holds a Doctor of Nursing Practice from Loyola University New Orleans, a Master of Science in Nursing, and a Bachelor of Science in Nursing from Virginia Commonwealth University. She is most enthusiastic about chronic disease management and teaching diabetes and hypertension to self-management to underserved populations. Kelva is the current president of the Central Virginia Chapter of CMSA and serves on the editorial board for CMSA Today.