Why can't they let me speak and listen

Éric-Olivier Sirois

Physiotherapist

September 22, 2022

Introduction 

Did you ever feel like your health professional was only there to complete his obligations and gather what he needed, leaving you with this unpleasant sensation of being a number and unheard? If yes, know that you are not the only one, and I've heard you.

In the last few years, I’ve realized that there was one common complaint which most people in my office had. Regardless of which body part was painful, one of the most frequent complaints I've heard is "they didn't listen to me/ I didn't feel understood." How can it be that people will say this before saying what is causing their pain and what they are avoiding because of it? This should not be a recurrent topic but unfortunately, it is, which is why I believe this article/conversation is necessary.

This article will go over the main way most health professionals gather information, and how we ask questions that often leave patients feeling misunderstood. This article is meant for patients and health professionals, as we all fall prey to these mistakes. 

Where Does the Problem Lie?

I don't believe people make these mistakes intentionally. I think this problem is rooted in the way we are taught in school and the human tendency to seek self-fulfilling stories and feel like we are helpful. There are two specific reasons why the way sessions are conducted often leads to this dissatisfaction and near-unanimous feeling of being unheard.

We ask too much and listen too littleWe use leading questions to bias people to say what we want to hear.

Part 1) We ask Too Many Questions and Listen too Little.

"If you listen for long enough, the patient will tell you exactly where the problem lies. If you cut them          off too often, you will find yourself searching for a long time."

One of my mentors told me this quote when I was still in my master's degree. This is likely the most valuable lesson I've learned so far in my practice. It does wonders for me daily. Too often, we forget we are only someone that is there to listen and guide people toward a safe and progressive return to function. We need to see ourselves more as a guiding hand than a healing one. 

What brings you here today? I am listening to you

How did I hear "they didn't listen to what I was saying/ I didn't feel understood" so often? Quite simply by asking my patient's concerns at the beginning of every first session with a straightforward question: What brings you here today, I am listening to you.

I want to go over a great article to shine a light on the flaws of our communication skills/approach with our patients. We will also see that asking this previous question alone is not enough. The magic happens when the "I am listening to you" segment happens after asking. As we all know, asking without listening is as good as never asking.

The study Eliciting the Patient's Agenda- Secondary Analysis of Recorded Clinical Encounters looked at:

The frequency at which primary care and specialty care providers asked such questions to their patients.How long did it take before the clinician interrupted the patient?When not interrupted, how long, on average, does the patient take to answer this specific type of question.

Here are the Conclusions from the Study

Clinicians elicited the patient's agenda (36%) of the time. In other words, only one-third of the clinicians felt it was important enough to invite the patient to list their points, related thoughts, and questions and ask whether they wanted a prescription, explanation, or investigation. No wonder patients feel like they are not being listened to.

2.     More frightening is how fast patients were interrupted when asked such questions. A whopping 11 seconds! That is how long, on average, a clinician took before interrupting his patient. This is outrageous!! And then we wonder why people are unsatisfied and complain about not being listened to and understood. 

3.     Many people will say this is easy to write about but not realistic to do in practice. By asking such open-ended questions, patients will take forever to answer. You will have no time left to do your tests and treat. From personal experience, I would say this is not true. Still, it is wrong to generalize to the masses from personal experience. Let's see what the same paper recorded as patients' average time to answer when uninterrupted. Uninterrupted patients took a median of 6 s, with answers ranging from 2 to 108 seconds to state their concerns.  

Surprising, isn't it? I know I was surprised when I saw those numbers. This study is proof that there is no good reason not to take the time to ask the person in front of you who is there because he is experiencing a problem, what brought them in today. Everyone can afford to let their patient talk for 2 minutes. There are those 1% of individuals that will, if not redirected, take 20 minutes to tell you everything from their neighbor’s dog's name to how 25 years ago they had a different hairstyle, but this is a tiny fraction of people. These outliers are not a reason to provide inadequate services for 99% of our patients. 

At the very least, I believe asking this one simple question is essential to know who and what we are dealing with. The rest of the session is unique to every answer you will get. For this reason, I cannot comment on how others utilize their time after those initial two minutes.

Take Away Message 

With all this evidence in sight, can we truly defend ourselves for not taking the time to ask our patients what brings them to us and listen to their concerns? The answer is no. If you believe you cannot afford 2 minutes with a patient, then I am tempted to say you should think of modifying how you manage your time and set your priorities. We must do better.

To read more on this topic, make sure to read the second part.

Seeking Guidance 

If you feel like you would benefit from an evaluation to identify and treat your pain from a health professional, you are welcome to make an appointment with me. It will be my pleasure to guide you and answer your questions. 

For more information, please read my other articles, which you can easily find on my profile. To discuss the information disclosed in this article, or if you believe a statement is outdated or not evidence-based, please feel free to reach out and let me know. I am always eager to learn. To do so, you can contact me by email at ericolivier.physio@gmail.com.

Reference

1.     Singh Ospina, N., Phillips, K.A., Rodriguez-Gutierrez, R. et al. Eliciting the Patient’s Agenda- Secondary Analysis of Recorded Clinical Encounters. J GEN INTERN MED 34, 36–40 (2019). https://doi.org/10.1007/s11606-018-4540-5

Pictures 

https://www.123rf.com/photo_4423767_dialogue-one-person-is-speaking-and-one-listening.html