April 2023 Communication Tip

April 2023 Communication Tip

Listening

I’ve mentioned listening before in this column (De-escalation 8/21/21, Demonstrating Respect 8/1/22).  This month, I wanted to dive a bit deeper into listening and how to listen well. Seems like it should be easy to listen (just sit there and don’t talk), but listening well is actually quite challenging.   Of course, we listen to our patients for lots of different reasons, many of them perfectly appropriate, efficient, and necessary.  However, let’s think for a moment about the art and practice of deep, open-ended, unconditional listening.

The biggest challenge of listening well is actually hearing what is true for the other (Rachel Remen’s “Generous Listening”), rather than hearing what fits into your pre-existing model about what should be said and felt, about what the truth is, about what the truth means.  It’s often hard to listen deeply without starting to worry about what we (the listener) need to do next.  What are the implications for me, now that the patient has said X, Y, or Z? 

Listening openly, generously, freely avoids judgement (about who the patient must be, about how we ourselves need to be seen).  Listening well means staying in the moment (being in the present), rather than going back to the past or trying to move prematurely into the future (or even avoid it entirely).  I’ve not been able to track the quotation down officially, but I believe the Philosopher Pascal once said, “We live in times not our own.”  [I base a lot of my life philosophy on that quote… so I hope someone said it!]

Rather than just listening, often we are actively trying to do other things, including guessing what the other is about to say.  Our phones, computers, and ChapGPT are doing this increasingly as we text and type.  But… we are not Generative Pre-Trained Transformers (the GPT of ChatGPT), instructed to use all the things we’ve heard or read before to predict the next thing that makes sense (in a way, potentially skipping over the present time).  In true listening, we are trying to stay open, in the present, in the middle, not relegating the speaker to just what’s been said or thought before or to a future that we can predict or abide by. 

It’s hard to stay in the middle, in that liminal space of just bearing witness to what is true for another.  But it’s key; it’s true. In fact, then our communication can become a chance to have our patients be seen and heard, a journey with our patients into the unknown (scary as that is). How do they really feel?  How are things really for them right now?  Only staying in the slightly uncomfortable present can we grow into the unknown future.  In genuinely knowing who the other is, we can be our own, true selves. 

Here's a favorite poem, new to me, that makes it clear what an exciting practice listening can be.

A Blessing for Epiphany

If you could see 
the journey whole 
you might never 
undertake it; 
might never dare 
the first step
that propels you 
from the place 
you have known 
toward the place 
you know not.

Call it
one of the mercies 
of the road:
that we see it
only by stages
as it opens
before us,
as it comes into 
our keeping
step by
single step.

There is nothing 
for it
but to go
and by our going 
take the vows
the pilgrim takes:

to be faithful to
the next step;
to rely on more
than the map;
to heed the signposts 
of intuition and dream; 
to follow the star
that only you 
will recognize;

to keep an open eye 
for the wonders that 
attend the path;
to press on
beyond distractions 
beyond fatigue 
beyond what would 
tempt you
from the way.

There are vows
that only you
will know;
the secret promises
for your particular path 
and the new ones
you will need to make 
when the road
is revealed
by turns
you could not 
have foreseen.

Keep them, break them, 
make them again:
each promise becomes 
part of the path;
each choice creates 
the road
that will take you 
to the place
where at last 
you will kneel

to offer the gift
most needed—
the gift that only you 
can give—
before turning to go 
home by
another way.

“For Those Who Have Far to Travel” © Jan Richardson from Circle of Grace: A Book of Blessings for the Seasons. 

All My Best,

Mike

P.S. You can find an archive of past communication tips here.