Often when we speak, we assume that the other person is intently listening to what we are saying. Unfortunately, this is not always the case. Without truly listening, proper communication cannot take place. This breakdown in communication is particularly devastating within the context of medical care, when a person’s health and well-being depends on the quality of communication.
Research has found that, on average, physicians interrupt patients after 23 seconds. This shows a lack of listening – a necessary skill for a correct diagnosis and treatment, which rely heavily on the information provided by the patient.
A recent review on patient-provider communication, validated across multiple studies, showed that as trainees progress through programs they experience a decline in empathy and communication. The review also demonstrated a link between poor communication and malpractice claims.
Finding ways to communicate that make a difference.
We recently demonstrated in a large research study funded by the National Institutes of Health that high quality communication can not only improve well-being, but can also decrease hospitalizations in patients with the very prevalent chronic condition of COPD or smoking-related lung disease.1
The study recruited more than 200 individuals hospitalized with COPD. After hospital discharge the patients were allocated to one of two treatments: usual care or usual care plus weekly personal follow-up of a health coach trained in a particular way of mindful communication called Motivational Interviewing.
The study results showed that the health coaching and motivational interviewing decreased hospitalization and improved well-being.
So what lessons can we take away from these findings?
(1) The need to promote mindful communication – a critical and perhaps underrated aspect of care that we firmly believe is at the heart of practicing the art of medicine.2
(2) The need to emphasize aspects like compassion (a true will to decrease suffering in the patient), empathy (an active effort to understand the other’s internal perspective and to see the world through their eyes), autonomy for self-care (honoring and respecting each person’s autonomy – their irrevocable right and capacity of self-direction) and the role of the health coach to facilitate activation of the person’s own motivation and resources for change.3
So how can we encourage providers to practice an active and compassionate listening to their patients? Encourage providers to listen compassionately to themselves: silence and meditation may work for that purpose. Cultivating the habit to listen to oneself may translate into better listening to others, such as patients.
Another way, is through the practice of mindfulness.
In a study published in the Journal of the American Medical Association, Michael Krasner and his colleagues studied the effects of an educational program in mindful communication on primary care physicians. The year-long course was divided into two phases: an 8-week intensive phrase and a 10-month maintenance phase.
The study found that participants became increasingly more mindful from baseline to the conclusion of the study, and that these effects were maintained at 3-months post intervention. Following the same pattern, the physicians also demonstrated a significant increase in empathy, specifically in perspective taking and standing in the patient’s shoes.
What it breaks down to is this: the price to pay for the breakdown in patient-provider communication is very high and the consequences can be significant. Learning to listen mindfully may be the way to a potential solution.