Epictetus, the ancient Greek philosopher, would have been a great optometrist. He’s quoted as saying, “We have two ears and one mouth so that we can listen twice as much as we speak.”
It’s been said before that a great case history is the most important aspect of treating a patient. But, to complete a good history, mastering two integral skills is necessary.
For starters, you have to know what questions to ask the patient. Secondly, and perhaps most importantly, you have to listen to the answers. Unfortunately, much of our training focuses on the first task, while completely ignoring the second.
Active listening, or disciplined listening—call it what you like—is not something we instinctively do. It’s just not generally a part of most non-clinical conversations. For that reason, it’s important to step back and consciously focus on it and train yourself to become an active listening expert.
Take a typical patient conversation that starts with you asking, “What brings you in to see us today?” Whether the patient responds with, “I’m here because you sent me a postcard,” or, “My contact lenses feel dry at the end of the day,” you have more than likely already mentally jumped to a diagnosis.
Without listening any further, you’ve already devised a treatment plan and have the requisite insurance codes in your head. While you are mentally processing all of that, the patient may follow up with some potentially significant information that you will totally miss. This is compounded by having to then worry about recording the patient history, which is another good reason to consider using a scribe.
When I perform mentalism for entertainment, acutely focused listening coupled with the observation of body language is a large part of what I do. Based on my own personal experience, I’ve discovered that it’s a trainable skill. In order to improve your listening skills, two simple yet extremely useful things must be practiced.
1. Let the patient talk.
Getting to the heart of the matter, or the chief complaint in our case, is something we want patients to do expeditiously and succinctly. After all, if we have a perfect understanding of exactly what the patient is describing, how long it’s been bothering them, etc., we feel we are better equipped to efficiently treat the ailment.
While there is certainly some diagnostic significance to “I don’t remember when the pain started” vs. “It started last Tuesday at 2:15 PM while I was at work on my computer,” it is critical that we are careful not to rush patients towards where they are going—or where we think they should go.
The preambles to their stories may often contain pearls of clinical value. But when a patient begins, “My brother-in-law told me a story about this guy he worked with, who he met on a cruise to Cozumel, who wears contact lenses…” we immediately roll our eyes without a thought, and want to tell the patient, “That’s great, but why are you here today?”
However, it’s often stories like these that, with just a bit of active listening and observation of body language, add important color commentary to a patient’s chief complaint: “That guy had something go really wrong with those lenses, and he can’t wear them anymore. So, if I get lenses, I don’t want the same kind he got at the gas station.”
And that is something that can lead to a potential lifelong effect on your patients’ contact lens wearing well-being, as it presents you the opportunity to respond with, “Of course, getting contact lenses from us is different than getting them from a gas station or flea market. Let me explain why this is a better approach. Also, if you follow our directions, you won’t have the same problems he had.”
2. Take your time.
Yes, easy for me to say while I’m writing this and I’m not three patients behind schedule, and constrained by decreasing reimbursements from vision care plans. But the reality is, slowing down by just a few seconds to intently listen to what your patient is saying, and not picking up your pen or mouse, can have a profoundly positive effect on your listening skills.
A great way to achieve this is to simply do nothing—don’t talk, write, click or do anything else—for one full second after a patient responds to you. I know, it will feel like an eternity at first, but it will force you to reflect, process and then appropriately respond to what you just heard.