Listening, not just hearing

How a graduation speech made me think about listening in healthcare, from both sides of the consultation room.

I had the privilege, recently, of hearing Dame Evelyn Glennie speak. She was giving out the awards at my son’s graduation ceremony. For those who don’t know her, she was the drummer at the 2012 Olympics opening ceremony. I had no idea that what she said would have so much relevance not only to the music graduates, but to me, and indeed all of us.

Listening in music, and in life

She talked about the importance of listening, what true listening really means and how it impacts all our lives. She said ‘musicians are all listeners, but listening is life, and listening is our best friend’. She spoke of the need for us all to be unselfish listeners so we can help one another. That listening to ourselves and each other allows a platform of curiosity to exist, and allows us to learn and be more adaptable.

She said, ‘listening offers continuity and connection, whereas hearing offers a full stop. It brings different minds together, and cements the power in partnerships. It can allow us to ask questions that no-one else dares to ask.’

She also advises listening to your own spoken thoughts as a necessary activity. That this helps to demonstrate compassion to yourself and others, and dissolves stigmas. She advises us to spend quality time with the what, why and how questions of our journey: ‘why’ requiring the most attention. She said, from this, ‘clarity can emerge, igniting conviction, choice and decision, and leaving room to build great listening bridges with all who you encounter’.

What is most striking about this speech is that Dame Evelyn Glennie has been profoundly deaf since childhood, and yet has made a career as a solo percussionist. She feels her music and plays barefoot in order to to do this. In her TED talk on the subject, she discusses first impressions when looking at, or hearing, a piece of music for the first time, and compares it with the way we judge someone when we first meet them and how wrong we can be, which we only realise after getting to know them. She describes how she takes time, listens with her body and opens herself up to that, and how she does not believe you listen with only your ears, but many different parts of your body. She advises us to listen with our eyes and feel with our hearts.

Maybe it takes someone who is profoundly deaf to show us the difference between hearing and listening. And how much of ourselves we need to use to truly listen.

Listening in healthcare - the doctor’s perspective

Her speech resonated so much with me ( pardon the pun!).

Listening properly has always been my pet subject in my job as a doctor, and particularly when teaching trainees. In a doctor’s consultation, there are so many visual cues as well as the words that are said. A person’s facial expression; their body language; how they point to the site of the pain; how they sit with arms folded in a defensive way when you ask them how many units of alcohol they drink. It’s what we lost for a while in the pandemic, having to do so much of our work remotely.

Dame Evelyn talks about how visual cues help sounds - for example, sometimes there is no sound but you are aware of the tension BEFORE the sound - or you might see a tree through a window, swaying in the wind and you can’t hear it, but you can imagine the rustling. In a similar way, a doctor can often tell how ill a child is even as they are brought into your room - a quiet child often being more of a worry - or how much anguish a person is in, before they even speak, just by looking at their face or the way they walk in.

She also described, when listening to music, how you have to test your listening skills. - use your whole body - stop the judgement ( don’t like the piece , listen again to see what it brings for you ) - give time. In the same way I needed to avoid jumping to conclusions and have time with people to really connect with them and interpret them. When stuck about what a patient needs, giving time, and actually listening, often gives us our answer.

Of course in a public health system, time is the thing we are often so short of. But there are techniques that can be taught: we talk about the ‘golden minute’ in the consultation. For doctors there is tendency to launch in with the questions, to try and answer our hypothesis, and deduce the nature, seriousness and possible solutions to the problem. But in fact, evidence shows that if we just stay quiet for that first minute, and actively listen to our patient, we will get to the root of the problem more efficiently and more quickly.

And listening needs to be active. When watching videos of consultations with trainees - a teaching method we use a lot - early on it is often necessary to point out how the patient is repeating themselves, because they have not felt heard. Actively responding to what is said, summarising the story back to the patient, reassures them that their story has been heard. Even assuming a posture that shows the patient you are ready to hear their story. That’s all we want, as patients, isn’t it : for someone to listen and make sense of our story.

I would say that, as a doctor, properly hearing the patient’s story is the most important thing in the job. In those consultations where you feel you are not getting anywhere, exploring the patient’s thoughts on their ideas and concerns, and what they expect from the consultation, usually provides the clarity we need.

Of course there are times when I’ve got it wrong. Clues will show themselves: the patient who says ‘thanks anyway doc’ on her way out. The one who, about to leave, with his hand on the door handle, says, ‘theres something else’ - although that can be because he was testing you with some easy stuff first, before he felt confident enough to ask his real burning question. But there is no doubt that in both these cases, there were probably visual cues that I should have been ‘listening’ to - a hesitancy in her face; his leaning forward at a point when I am closing the conversation.

But when you are properly listening, and you feel connected with that patient, you feel it in your heart as well as your head. I would get a slight pressure behind my right ear when ‘in flow’ with a patient. And this is no surprise as that is where the temporal lobe of the brain is, that processes auditory information, encodes memories, and plays a role in language, emotions and visual perception.

Listening in healthcare - the carer’s perspective

Sharing my husband’s journey through cancer care has taught me a lot about the importance of listening, from the other side. We have seen what it feels like to NOT be listened to. The arrogant consultant who gives a monologue and does not listen to our concerns: a lack of time meaning he just wants to get the job done; or the walls he has built up in order to protect himself from patients’ emotions over the years. Not listening to us was one thing, but not listening to his own words and considering their impact, was another. When we mentioned concerns about delays, amid worsening symptoms, he decided to describe the exponential growth of a tumour: a tone deaf response to our worries.

You leave a meeting like that feeling angry and unheard. We have struggled with the decisions made in MDT’s ( teams of consultants ) behind closed doors, where the patient's point of view is not heard. In one hospital they left all the direct conversations with patients to the nurse specialist and you never got to speak to the consultants making the decisions. I resorted to writing a letter about ‘the man behind the scan’ to the team, in order to get our point across when things became tricky and we feared a decision would be made to let him die. In another hospital, you could speak to the consultants while the MDT took place in the next room, in between cases, so you felt more like a human than a number. And as a result, you felt safer.

When there were errors with medication on the ward, trying to raise this, we didn’t feel heard. I had to write another letter, to get my point across. Errors will happen, but it’s so important to listen to patients when they do. Without this, patients feel disempowered and unsafe. And equally, in a team, there is a need to listen to each other when things go wrong, so that full discussion can take place about putting things right and avoiding future errors.

We have also experienced how wonderful it is when a caregiver does have the time to truly listen.The nurse specialist who listened actively to Den’s symptoms, and provided solutions that made a real difference. The nurse on the ward who stopped what she was doing and sat down to talk to Den about his near-death experience. The oncologist who delved into other options at our request, and, through listening, understood that Den would take on more risk, with lower odds of cure, than the average person.

How much richer - and safer - Den’s healthcare journey has felt when people have stopped and truly listened. Healthcare is, by necessity, scientific, and evidence-based. And a resource-strapped, understaffed service can struggle to have enough time to listen. But it is hearing people’s stories that brings the humanity into medicine.

So I agree with Evelyn Glennie, about how many of our senses we use to truly listen, and how we need to take time to do it. And how important this is in music, and healthcare, and indeed in life.