research on questions about doctors listening

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Listening Full Test 2 - Section 4

I’ve been doing some research into what people in Britain think of doctors, the ones who work in general practice – the first call for me medical care – and comparing this with the situation in a couple of the countries. I want to talk about the rationale behind what I decided to do.

Now I had to set up my programme of research in there different countries so I approached postgraduates in my field in overseas departments(Q31) , contacting them by email, to organize things for men at their end. I thought I would have trouble recruiting help but in fact everyone was very willing and sometimes their tutors got involve too.

I had to give my helpers clear instructions about what kinds of sample population I wanted them to use. I decided that people hat people under 18 should be excluded because most of them are students or looking for their first job, and also I decided at this stage just to focus on men who were in employment(Q32) , and set up something for people who didn’t have jobs and for employed women later on as separate investigation.

I specifically wanted to do a questionnaire, and interviews with a focus group. With the questionnaire, rather than limiting it to one specific point, I wanted to include as much variety as possible(Q33) . I know questionnaire area very controlled way to do things but I thought I could do taped interviews later on to counteract the effects of this. And the focus group may also prove useful in future, by targeting subjects I can easily return to, as the participants tend to be more involved.

So I’m collating the results now. A the moment it looks as if, in the UK, despite the fact that newspaper continually report that people are unhappy with medical care, in fact it is mainly the third level of care, which takes place in hospitals, that they are worried about(Q34) . Government reforms have been proposed at all levels and although their success is not guaranteed, long-term hospital care is in fact probably less of an issue than the media would have us believe. However, I’ve still got quite a bit lot of data to look at.

Certainly I will need to do more far-reaching research than I had anticipated in order to establish if people want extra medical staff invested in the community, or if they want care to revert to fewer, but larger, key medical units(Q35) . The solution may well be something that can be easily implemented by those responsible in local government, with central government support of course.

This first stage has proved very valuable though. I was surprised by how willing most of the subjects were to get involved in the project – I had expected some unwillingness to answer questions honestly. But I was taken aback and rather concerned that something I thought I’d set up very well didn’t necessarily seem that way to everyone in my own department(Q36) .

I thought you might also be interested in some of the problems I encountered in collecting my data. There were odd cases that threw me –one of the subjects who I had approached while he was out shopping in town, decided to pull out when it came to the second round (Q37) . It was a shame as it was someone who I would to have interviewed more closely.

And one of the first-year studentsI interviewed wanted reassurance that no names would be traceable from the answers(Q38) . I was so surprised, because they think nothing of telling you about surprised, because they think nothing of telling you about themselves and their opinions in seminar groups!

Then, one of the people that I work with got a bit funny. The questions were quite personal and one minute he said he’d do it, then the next day he wouldn’t, and in the end he did do it(Q39) . It’s hard not to get angry in that situation but I tried to keep focused on the overall picture in order to stay calm.

The most bizarre case was a telephone interview I did with a teacher at a university in France. He answered all my questions in great detail – but then when I asked how much access he had to dangerous substances he wouldn’t tell me exactly what his work involved (Q40) . It’s a real eye- opener…

Questions 31-36

Choose the correct letter, A, B or C. RESEARCH ON QUESTONS ABOUT DOCTORS

31. In order to set up her research programme, Shona got

A. advice form personal friends in other countries.

B. help from students in other countries.

C. information from her tutor’s contacts in other countries

32. What types of people were included in the research?

A. young people in their first job

B. men who were working

C. women who were unemployed

33. Shona says that in her questionnaire her aim was

A. to get a wide range of data.

B. to limit people’s responses.

C. to guide people people through interviews.

34. What do Shona’s initial results show about medical services in Britain?

A. Current concern are misrepresented by the press.

B. Finance issues are critical to the government.

C. Reforms within hospitals have been unsuccessful.

35. Shona needs to do further research in order to

A. present the government with the findings.

B. decide the level of extra funding needed.

C. indentify the preferences of the public.

36. Shona has learnt from the research project that

A. it is important to plan projects carefully.

B. people do not like answering questions.

C. colleagues do not always agree.

Questions 37-40

People interviewed by Shona

37. a person interviewed in the street ……………………..

38. an undergraduate at the university …………………….

39. a colleague in her department ………………………..

40. a tutor in a foreign university ………………………..

[bg_collapse view=”button-orange” color=”#4a4949″ icon=”eye” expand_text=”Show Answer” collapse_text=”Hide Answer” ]

31: B . help from students in other countries.

32: B . men who were working

33: A. to get a wide range of data.

34: A . Current concern are misrepresented by the press.

35: C. indentify the preferences of the public.

36: C. colleagues do not always agree.

37: B. decided to stop participating

38: F. was worried about confidentiality

39: D. kept changing their mind about participating

40: C. refused to tell Shona about their job

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What is Public Health?

Improving Patient-Doctor Communication

Improving how patients and their doctors communicate can lead to greater trust and better health outcomes.

Stephanie Desmon

When patients don’t feel heard by their doctors, there’s an erosion of trust that can lead to serious health consequences—even if clinicians have their patients’ best interests in mind.

Mary Catherine Beach, MD, MPH , a professor in the Department of Health, Behavior and Society and at the Johns Hopkins School of Medicine, studies patient-provider communications. In an episode of Public Health On Call , she talks about what can happen when patients don’t feel heard, ways to teach providers better communication skills, and how biases can come into play.

How can you tell if your health care provider is listening to you?

As a patient, you’re looking for your doctor to show you that they have heard what you said and they understand it. That might mean that you’re looking at them while you’re talking, and the physician is looking back at you, nodding, or making eye contact. Or they’re reflecting back what you said by paraphrasing you or asking questions that are relevant to what you shared.

If someone feels like their doctor isn’t listening, what options do they have?

There are a couple of options. The first is to say something like, “I want to make sure that I've been totally clear, because my main concern is <state the main concern>” or “I have a couple of questions that I really need answers to.” By doing this, the patient can make clear that they actually need to pause and get some sort of positive response. It is possible that a physician is not showing you that they're listening, but they are indeed taking in what you’re saying.

If you find yourself having to do that repeatedly, and a practitioner is still not listening to you, you should be looking for a new provider if possible.

That seems like a pretty big burden to put on the patient.

I spend most of my time trying to improve the way health professionals communicate. That includes things like proactively showing patients that they're listening, explaining things in a way that the average person can understand, not giving long lectures using big words. I also encourage them to ask patients what they would like to hear or what questions they have before launching into long explanations. These are all ways to get patients more engaged, because as a patient, if you’re talking more, you're going to remember more.

I do think that the burden should be on the health professionals to do this well, but there are so many challenges. So in absence of that, it's also important to empower patients to get what they need.

This role of the provider-patient relationship in health care is really fundamental to being healthy people, isn't it?

It totally is. If you don’t feel like you can trust your health care provider—that they’re not listening to you or not competent—or if you aren’t 100% certain they have your best interests at heart, you may not feel confident in following their advice. Our research has shown that people who feel they don’t have a good relationship with their doctor are a lot less likely to take lifesaving medications.

How have you worked with providers to improve the ways they interact and build relationships with patients?

We’ve done a couple of interventions where we have met with clinicians and reviewed common provider-patient conversations. For example, we worked with clinicians on how to talk more effectively with patients about adherence to medications .

Typically if a patient says they’re not taking medication, the clinician tends to jump in and explain why that’s bad and why they need to take their medications. We encouraged them to instead step back and ask questions to understand what’s motivating the patient’s decision to not take medication: What are their thoughts on the medications? Do they feel medications are a good idea? Do they feel it's important to take the medications?

This pulls from the field of motivational interviewing, which involves learning from people what they think is important and what they’re willing to do. And because the communication techniques in motivational interviewing are so different from what we’re typically taught as physicians, that can be really groundbreaking in showing physicians a different, better way to communicate. Physicians are actually very motivated to change how they talk to patients so that they can be more effective.

What about working with patients to change how they approach these interactions?

I haven’t personally done a lot of work with activating patients. There have been studies that tried to work with patients in waiting rooms, to get them to write down their questions or write down the specific issues they want to talk to their physician about. But I don’t think there's been as much work there. And that’s mainly because it feels like a lot of pressure to put on patients.

View this post on Instagram A post shared by Johns Hopkins Public Health (@johnshopkinssph)

The patient-provider relationship obviously is key to a person’s health care experience. Do certain patient populations tend to face more issues in building that trusting relationship?

Yes, there is substantial research looking at how communication differs by patient race and some by patient gender. Unfortunately, the studies show that doctors tend to talk a lot more relative to Black patients compared to white patients . The term that we use for that in communication research is “verbal dominance.”

Related to whether patients feel listened to is the phenomenon of whether a doctor takes seriously what a patient tells them. We’ve done studies that show that Black patients feel like their concerns are dismissed a lot more than white patients. We’ve also looked at the language doctors use in patient medical records that might indicate whether they believe a patient, and that research showed more indications in the records of Black patients that a physician doubted what the patient said.

How do other personal biases play into patient care and potential barriers to accessing care?

Like any person, providers will sometimes have opinions about how to live a good life and what people should or shouldn’t do. Personality research has shown that some people are naturally more dogmatic and judgmental of others. Doctors are just like anybody else. And if they’re judgmental of somebody’s choices, that’s going to be conveyed in how they communicate with the person.

We’re empowered as doctors to feel like we have all this medical knowledge, so we get excited at the idea that we can help with a particular treatment. And if somebody decides they don’t want that treatment, a lot of times doctors will get frustrated, and sometimes that’s because they really care. That frustration doesn’t all come from a bad place, but it doesn’t make the patient feel respected when a doctor judges their choices.

Stephanie Desmon is the co-host of the Public Health On Call podcast. She is the director of public relations and communications for the Johns Hopkins Center for Communication Programs , the largest center at the Johns Hopkins Bloomberg School of Public Health.

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Health Care

Teaching doctors to be better listeners.

If doctors listen more carefully to patients' conversations about work and family life, they can pick up clues that lead to better treatment, according to a study in the Journal of the American Medical Association. Author Dr. Alan Schwartz talks about training doctors to be better listeners.

Cambridge - IELTS 8 Answer Key

Book 8 - listening test 2 solution, section - 1 total insurance incident report.

Answer Key for Total Insurance Incident Report Listening Test

6. door 7. 140 8. leg 9. plates 10. 60

Section - 2 Agricultural Park

Answer Key for Agricultural Park Listening Test

11. B 12. (the) Forest 13. Fish Farm(s) 14. Market Garden 15. C

Section - 3 Honey Bees in Australia

Answer Key for Honey Bees in Australia Listening Test

21. A 22. B 23. C 24. A

Looking for Asian honey bees 25. insects

26. feeding/eating 27. laboratory 28. water 29. wings 30. reliable/accurate

Section - 4 Research on questions about doctors

Answer Key for Research on questions about doctors Listening Test

31. B 32. B 33. A 34. A 35. C

36. C 37. B 38. F 39. D 40. C

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IELTS Listening Multiple Choice Questions in Section 4 (Doctors)

By ieltsetc on June 15, 2018

IELTS Listening Multiple Choice questions (MCQs) consist of 3 choices, so are easier than Reading. Section 4 is usually made up of gapfill questions, but multiple choice questions are also common.

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Open access
Published: 08 March 2024

The relationship between Empathy and listening styles is complex: implications for doctors in training

Amir Beheshti 1 , 2 ,
Farzin Tahmasbi Arashlow 3 ,
Ladan Fata 1 ,
Farzaneh Barzkar 1 &
Hamid R. Baradaran 1

BMC Medical Education volume 24 , Article number: 267 ( 2024 ) Cite this article

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Metrics details

Effective communication is the key to a successful relationship between doctors and their patients. Empathy facilitates effective communication, but physicians vary in their ability to empathize with patients. Listening styles are a potential source of this difference. We aimed to assess empathy and listening styles among medical students and whether students with certain listening styles are more empathetic.

In this cross-sectional study, 97 medical students completed the Jefferson scale of Empathy (JSE) and the revised version of the Listening Styles Profile (LSP-R). The relationship between empathy and listening styles was assessed by comparing JSE scores across different listening styles using ANOVA in SPSS software. A p-value less than 0.05 was considered significant.

Overall, the students showed a mean empathy score of 103 ± 14 on JSE. Empathy scores were lower among clinical students compared to preclinical students. Most of the medical students preferred the analytical listening style. The proportion of students who preferred the relational listening style was lower among clinical students compared to preclinical students. There was no significant relationship between any of the listening styles with empathy.

Our results do not support an association between any particular listening style with medical students’ empathic ability. We propose that students who have better empathetic skills might shift between listening styles flexibly rather than sticking to a specific listening style.

Peer Review reports

Physicians must communicate effectively with their patients to achieve the shared goal of the clinical encounter: favorable clinical outcomes [ 1 ]. Effective communication can improve patient engagement and satisfaction [ 1 , 2 ]. The doctors’ communication skills and empathy are among the most critical factors for a satisfying patient-physician relationship [ 3 ].

Empathy is the ability to take the other person’s perspective during a conversation [ 4 ]. It is a multi-faceted process composed of affective and cognitive aspects [ 5 ]. While the affective dimension involves ‘feeling’ how the other person feels, the cognitive element of empathy involves understanding the person’s situation and how it has impacted their feelings [ 6 ]. More empathetic physicians are at a lower risk of burnout; their patients experience less distress and are more satisfied with care [ 7 ]. A closely related skill to empathy is active listening, defined as ‘listening and responding to another person in a way that facilitates mutual understanding’ [ 8 ].

Some studies suggest that physicians may find active listening hard [ 9 ]. Active and reflective listening requires the physician to focus on the emotional and personal aspects of the patient’s complaints [ 10 ]. It involves actively listening to patients, understanding their emotions and perspectives, and responding in a way that shows empathy and understanding [ 10 ].

People tend to have different listening preferences. Some people prefer to listen for facts or statistics, while others prefer personal examples. Some prefer to concentrate on content, while others prefer concise and ‘to the point’ presentations [ 11 , 12 , 13 , 14 ]. This variation reflects attitudes, beliefs, and predispositions toward the ‘how’, ‘where’, ‘when’, ‘who’, and ‘what’ of the information reception and encoding process. This concept is collectively referred to as ‘listening style’ [ 11 , 15 ].

The listening styles profile is a practical approach to studying individual listening preferences [ 13 , 16 ]. This approach categorizes listening preferences based on the focus of information gathering into ‘people-oriented(or relational)’, ‘action-oriented(or functional)’, ‘content-oriented(or analytical)’, and ‘time-oriented(or time)’. People tend to have a combination of preferred listening styles.

The revised version of the tool categorizes listening styles into relational, analytical, time-oriented, and critical [ 16 ]. Individuals using the relational listening style tend to care more about others’ feelings and emotions. They try to find areas of common interest with others and respond to their emotions. Functional listeners have a preference for receiving concise, error-free presentations. They are impatient and are easily frustrated when listening to a disorganized presentation. Individuals endorsing analytical listening styles prefer receiving complex and challenging information. They try to evaluate facts and details carefully before forming judgments and opinions. Time-oriented listeners reflect a preference for brief or hurried interactions with others. They tend to let others know how much time they had to listen or tell others how long they had to meet [ 16 ].

A study on the correlation between listening styles and active empathetic listening found strong connections between relational listening styles and the three stages of active empathetic listening (AELS). Analytical listening styles were found to be strongly correlated with processing and responding in the AELS, while functional listening styles were strongly correlated with processing in the AELS [ 12 ].

Research has shown that the listening styles of patients are linked to their medical communication competence, influencing their information exchange and socioemotional communication in healthcare settings [ 17 ]. Whether or not the personal preference of certain listening styles affects a physician’s ability to empathize can reveal valuable information regarding the nature of empathy and the reasons behind individual differences in empathic ability among physicians [ 14 , 18 , 19 ]. This information can have educational implications by shedding light on the process of empathy and how it is affected by listening styles at different stages of medical training. In other words, developing certain listening styles may be a potential educational target for teaching empathy.

We aimed to examine whether the medical students’ empathy levels and listening styles were related. We also aimed to assess the level of empathy and distribution of listening styles among medical students at different levels of their training.

Design, participants, and setting

All medical students( n = 1146) at Iran University of Medical Sciences, Tehran, Iran were eligible to participate in the study. In this cross-sectional study, 100 medical students were randomly selected and contacted and random numbers based on the students’ matriculation numbers in the university’s educational registry system. Participants were selected proportionately from different stages of their undergraduate medical training, including preclinical, clerkship, and internship. Gender was also considered when selecting the students so that the proportion of men and women would be similar at all stages.

Undergraduate medical training in Iran takes seven years and consists of four stages: basic sciences(5 semesters), pathophysiology(4 semesters), clerkship(4 semesters), and internship(3 semesters). The graduates receive an MD degree and are allowed to practice as general practitioners and family physicians. They may also get into residency programs to receive further training as specialists.

All participants completed a paper-based Persian questionnaire that consisted of the Jefferson Scale of Empathy (JSE) and the revised version of the Listening Styles Profile [ 20 , 21 , 22 ]. The participants also answered questions regarding sex, age, and marital status. The study protocol was approved by the institutional review board of the authors’ affiliated institution. All procedures conformed to the tenets of the Declaration of Helsinki.

The Jefferson scale of empathy

The Jefferson scale of empathy is a 20-item questionnaire that measures empathy in the clinical setting [ 23 ]. The respondents rate each item on a 7-point Likert scale from ‘strongly disagree’ to ‘strongly agree’. The instrument has been adopted widely and has been shown to be valid and reliable in different contexts and across genders [ 21 ]. It measures empathy in 3 subscales(factors): ‘perspective taking, compassionate care, and ability to stand in patients’ shoes’. The student version of JSE was translated to Persian and validated by Shariat, et al. and showed an acceptable level of reliability [ 20 ]. This tool is the most widely adopted tool measuring empathy in the clinical setting [ 24 ]. Thus, the use of this tool would allow for an understanding of the nature of empathy as is discussed in the available literature on this subject.

The listening styles profile

The Listening Styles Profile (LSP) is a self-administered questionnaire containing 20 questions that is designed to assess four different approaches to gathering information: people-oriented, action-oriented, content-oriented, and time-oriented styles. This questionnaire was initially designed by Watson in 1995; A revised version-which is used in the current study- was developed by Graham et al. in 2013 [ 10 , 13 , 16 ]. The revised version categorizes listening styles into relational, analytical, task-oriented, and critical. The tool was translated to Persian and validated in 2017 by Fatehi for use in medical sciences students and showed a Cronbach’s alpha of 0.72 [ 25 ]. Each listening style is scored based on six questions and a 7-point Likert scale yielding total scores that range from 0 to 42 [ 25 ].

Statistical analysis

The sample size was calculated using the formula for correlational studies. Assuming a coefficient of 0.280 based on previous studies, a confidence level of 95%, and a power of 80, the number 98 was calculated [ 12 ].

Descriptive statistics were employed, including mean ± SD for continuous outcomes and rate(percent) for categorical variables, to present our data. Mean scores ± SD for JSE and mean scores ± SD for all listening styles were calculated for all participants. Means of JSE scores across students at different educational stages were compared using ANOVA. Mean JSE scores were compared between men and women using the student’s T-test. The correlation between listening styles and empathy scores was assessed using linear regression.

Participants’ characteristics

A total of 97 medical students agreed to participate in this study. The sample comprised 51(52.6%) women and 46(47.4%) men. Participants’ age ranged from 14 to 29 years (Mean = 22, Standard Deviation(SD) = 3). Fifty-four students were living in Tehran, and 43 students were from other parts of the county living in the dormitory. The characteristics of the participants based on their educational stages are shown in Table 1 .

Means and standard deviations of empathy scores in each stage are reported in Table 2 . The mean empathy score among participants was 103 ± 14. Although mean empathy scores were slightly higher among women compared to men, the difference in means was not statistically significant (Mean Difference = 2, 95%CI [-3.84 to 7.84], p-value = 0.08). As can be noticed in Table 2 , mean empathy scores were lower in students at later stages of their training than in preclinical students. This difference was statistically significant(p-value = 0.01).

Listening styles

Analytical listening obtained the highest mean score among medical students (Mean 31, 95% CI [29.8, 32.2]), followed by relational listening style (Mean: 27, 95% CI [26.2, 27.8]). The distribution of listening styles did not differ based on participant gender. The distribution of listening styles in participants at different stages of their training is presented in Fig. 1 . Relational listening scores were lower among clinical compared to preclinical students, while analytical and task-oriented listening styles were higher in clinical students, and critical listening style remained constant at about 20 across all training stages. None of the observed trends in listening styles across training stages were statistically significant.

Listening styles among medical student participants at different stages of their training. The vertical axis shows the mean scores acquired by the students’ group in each listening style

Empathy scores were not significantly correlated with any type of listening style. The correlation coefficients for empathy scores with each of the listening styles are presented in Table 3 .

Both empathy and effective listening play an important role in the physician-patient relationship [ 5 , 26 , 27 ]. Contrary to expectations, that higher levels of empathy would be associated with a preference for a relational or people-oriented listening style, our results showed that no particular listening style was associated with higher empathy scores among medical students. This finding may be routed in differences in nature between empathy and listening styles. While relational listening style reflects the degree of concern for the patients’ emotions, the JSE measures empathy as a stable cognitive ability that is modified by the physician’s skills in perspective taking, compassionate care, and putting oneself in patient’s shoes in contrast to empathic concern which is the affective component of empathy [ 5 , 12 ].

One study that assessed listening styles and empathic listening among nursing students reported that a preference for people-oriented listening style was associated with all three components of empathic listening: sensing, processing, and responding; Content-oriented listening style was correlated with processing and responding components of empathic listening. And, action-oriented listening style was strongly correlated with the processing element of empathic listening. Thus, it can be inferred that empathic listening encompasses a combination of listening styles that are used flexibly rather than a fixed preference for the relational or people-oriented listening styles [ 12 , 17 ]. Moreover, listening styles are more state-related and contextual constructs in contrast to empathy that is more stable; In other words, people tend to have multiple preferred listening styles they employ in different settings [ 11 ].

Neuroscience research also provides evidence that empathy is a complex phenomenon that involves multiple components executed by different parts of the brain with distinct functions. The right temporal lobe, where mirror neurons reside, has been shown to be activated during the process of perspective empathy [ 28 ]. The posterior part of the inferior frontal gyrus is activated when we are trying to understand the intentions of others [ 29 ]. Anterior part of insula and anterior cingulate gyrus are activated when perceiving empathic distress [ 30 ]. The fact that distinct brain areas are involved in different components of empathy, is also in alignment with the idea that empathic skills constitute a complex set of cognitive abilities including different areas related to listening rather than a simple concern for others mediated by mirror neurons as in the relational listening style.

Medical students who participated in our study preferred analytical listening styles; Although they scored above 20 in all listening styles, showing a moderate tendency to use each of them. Research suggests that most individuals have a combination of preferred listening styles which may change over time [ 10 , 11 , 16 ]. The choice of specific listening styles is based on personal habit and preferences modulated by factors such as sex and gender roles as well as demands from the working environment [ 11 ]. While the students in our study scored lower on empathy and relational listening style at later stages of their education, interns scored higher on analytical listening style compared to preclinical students. The participants in our study scored high on analytical listening style which according to previous research contributes to careful assessment of different aspects of an issue and perspective taking [ 16 ].

According to our findings, although women scored higher in JSE-S than men, the difference was not statistically significant. Patterns of listening styles were also different between men and women. Although small in size, sex-related differences in empathy and patterns of listening styles have been well recognized and studied [ 11 ]. Men tend to prefer content and action-oriented listening styles while women show a stronger preference for people- and action-oriented styles [ 31 , 32 ]. These differences have been attributed to both gender-roles and biological differences [ 25 , 32 ]. In other words, independent of biological sex, people with communal gender roles prefer relational and people-oriented listening in contrast to people with agentic gender roles who prefer action-, content-, and time-oriented listening styles [ 11 ].

Considering different educational stages, we observed that students at later stages of their training scored significantly higher in task-oriented listening style. Mean empathy score was also significantly lower among participants in clinical training compared to preclinical students. Several studies have shown a decline in students’ empathy during medical school training. The literature suggests some reasons for this trend: (1) empathetic disengagement due to heavy emotional load associated with clinical encounters during training [ 33 ], (2) lack of emotional literacy, (3) gradual sensory desensitization to patients’ pain as a result of continuous exposure [ 33 ], and (4) empathy is a protective factor for burnout. Other reasons include mental health challenges such as depression and burnout that arise during medical training and have been shown to affect empathic capacity, a problem-solving in contrast to relational culture in medical schools, and higher workloads which are a barrier to communication with patients [ 34 , 35 , 36 , 37 ].

Several ways have been suggested to improve listening skills in health care providers can. One study emphasizes inclusion of a listening skills course in the medical school curriculum that provides advanced communication training [ 38 ]. They emphasized teaching of active and empathetic listening, as well as the use of nonverbal cues and reflective techniques. Minimizing distractions, validating patients’ feelings, and promoting cultural competence are also noted as essential components of effective listening. The article also suggests receiving feedback and engaging in self-reflection for life-long learning of listening skills [ 38 ]. To further improve listening skills among medical students, it is essential to provide explicit training in clinical reasoning and communication skills, as well as to incorporate interactive methods of teaching, such as simulated patients and case-based role-plays [ 39 , 40 ]. The integration of clinical reasoning with communication skills training has also been proposed as a solution to students’ confusion over their choice between attentive listening for emotions and listening for problem-solving [ 41 ].

The participants in our study scored an overall mean of (M = 103 ± 14) on the JSE. This is very close to the findings of previous studies from Iran and other Asian countries while lower than scores of medical students in the US, Mexico, and Portugal. This difference may be attributed to cultural differences in healthcare systems, the medical school admission criteria, and educational programs across countries. Another explanation that physicians who are affected by burnout score lower on the JSE; Thus, the lower empathy scores in our study are related to higher rates of burnout in Middle-Eastern and Asian countries [ 35 , 42 , 43 ].

In concluding this study, one should consider some limitations. First, given that our sample consisted of ninety-seven medical students attending the same university, the study would have benefited from a greater number of participants at various universities in Iran. Secondly, our findings may be altered by potential confounding factors such as burnout and personal characteristics that affect empathy and we did not adjust for in our analyses [ 43 ]. Thirdly, this study was the first study that used the revised version of Graham Listening Styles Questionnaire for this purpose. Thus, findings cannot be reliably compared to other studies measuring listening style profiles using the initial version of the questionnaire. Fourthly, since empathy was assessed using JSE which measures clinician empathy in three cognitive dimensions of perspective taking, compassionate care, and walking in the patient’s shoes, our findings cannot be generalized to concepts related to the affective component of empathy including empathic concern. Moreover, we only used mean scores of empathy in order to assess the relationship between empathy and listening styles, and we did not collect detailed data on different subscales of empathy.

We suggest that future studies focus on the use of different listening styles in different settings and how the flexible use of listening styles relates to empathic skills. Specifically, studies may test whether a flexible use of listening styles is correlated with better empathy. Another suggestion would be that future studies include more students which could enable comparing different components of empathy across different listening styles. Also, future studies may want to assess the same issue from the patients’ perspective. We also suggest measuring burnout as a confounding factor in future studies. Another interesting research would involve creating and testing the efficacy of empathy training modules that focus on the flexible use of listening styles.

Conclusions

Empathy strongly affects the relationship between doctors and patients. In the current study, empathy did not correlate with any of the four listening styles among medical students and interns. It is suggested that physicians with good communication skills, flexibly modify their listening style based on individual clinical contexts rather than preferring certain listening styles over others for all clinical situations.

Data availability

The datasets used and analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We are thankful to the medical students at IUMS who accepted to participate in this study.

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Amir Beheshti took major executive role in conducting the project; Farzin Tahmasbi Arashlow and Farzaneh Barzkar co-drafted the manuscript, interpretated the data, and conducted the literature review. Ladan Fata and Hamid R Baradaran contributed to the study design and supervised all the steps. All authors read and approved the current version of this manuscript.

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Beheshti, A., Arashlow, F.T., Fata, L. et al. The relationship between Empathy and listening styles is complex: implications for doctors in training. BMC Med Educ 24 , 267 (2024). https://doi.org/10.1186/s12909-024-05258-9

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Wait, just a second, is your doctor listening?

Analysis of clinical encounters shows that doctors spend little time first listening to their patients and interrupt them often

Heidelberg | New York, 19 July 2018

Journal cover: Journal of General Internal Medicine

The researchers analyzed the initial few minutes of consultations between 112 patients and their doctors. These encounters were videotaped in various US clinics during training sessions for doctors. In their analyses, Singh Ospina and her colleagues noted whether, for instance, doctors invited patients to set the agenda through opening questions such as “How are you?” or “What can I do for you?” The researchers also recorded whether patients were interrupted when answering such questions, and in what manner.

In just over one third of the time (36 per cent), patients were able to put their agendas first. But patients who did get the chance to list their ailments were still interrupted seven out of every ten times, on average within 11 seconds of them starting to speak. In this study, patients who were not interrupted completed their opening statements within about six seconds.

Primary care doctors allowed more time than specialists and tended to interrupt less. According to Singh Ospina, specialists might often skip the introductory step of agenda setting because they already know why a patient has been referred.

“However, even in a specialty visit concerning a specific matter, it is invaluable to understand why the patients think they are at the appointment and what specific concerns they have related to the condition or its management,” adds Singh Ospina.

She acknowledges that the frequency of interruptions not only depends on the type of practice being visited, but also relates to the complexity of each patient.

“If done respectfully and with the patient’s best interest in mind, interruptions to the patient’s discourse may clarify or focus the conversation, and thus benefit patients,” she agrees. “Yet, it seems rather unlikely that an interruption, even to clarify or focus, could be beneficial at the early stage in the encounter.”

Time constraints, not enough training on how to communicate with patients, and burnout experienced by physicians may stand in the way of a more patient-centred approach. Singh Ospina would like to see further studies exploring a possible link between a patient being given a chance to set his or her agenda, and the ultimate experience and outcomes of their visit to their doctor.

“Our results suggest that we are far from achieving patient-centred care,” she says.

Reference: Singh Ospina, N. et al (2018). Eliciting the Patient’s Agenda- Secondary Analysis of Recorded Clinical Encounters , Journal of General Internal Medicine DOI: 10.1007/s11606-018-4540-5

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Wait, just a second, is your doctor listening?

Analysis of clinical encounters shows that doctors spend little time first listening to their patients and interrupt them often

On average, patients get about 11 seconds to explain the reasons for their visit before they are interrupted by their doctors. Also, only one in three doctors provides their patients with adequate opportunity to describe their situation. The pressure to rush consultations affects specialists more than primary care doctors says Naykky Singh Ospina of the University of Florida, Gainesville and the Mayo Clinic in the US. She led research that investigated the clinical encounters between doctors and their patients, how the conversation between them starts, and whether patients are able to set the agenda. The study is in the Journal of General Internal Medicine which is the official journal of the Society of General Internal Medicine and is published by Springer.

The researchers analyzed the initial few minutes of consultations between 112 patients and their doctors. These encounters were videotaped in various US clinics during training sessions for doctors. In their analyses, Singh Ospina and her colleagues noted whether, for instance, doctors invited patients to set the agenda through opening questions such as "How are you?" or "What can I do for you?" The researchers also recorded whether patients were interrupted when answering such questions, and in what manner.

"However, even in a specialty visit concerning a specific matter, it is invaluable to understand why the patients think they are at the appointment and what specific concerns they have related to the condition or its management," adds Singh Ospina.

She acknowledges that the frequency of interruptions not only depends on the type of practice being visited, but also relates to the complexity of each patient.

"If done respectfully and with the patient's best interest in mind, interruptions to the patient's discourse may clarify or focus the conversation, and thus benefit patients," she agrees. "Yet, it seems rather unlikely that an interruption, even to clarify or focus, could be beneficial at the early stage in the encounter."

"Our results suggest that we are far from achieving patient-centred care," she says.

Reference: Singh Ospina, N. et al (2018). Eliciting the Patient's Agenda- Secondary Analysis of Recorded Clinical Encounters, Journal of General Internal Medicine DOI: 10.1007/s11606-018-4540-5

Journal of General Internal Medicine

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Kindness, Listening, and Connection: Patient and Clinician Key Requirements for Emotional Support in Chronic and Complex Care

Jane bradshaw.

1 University of Tasmania, Health Service Management School of Business & Economics, Sydney, Australia

2 Be Pain Smart Service, Royal Rehab, Ryde, Australia

Nazlee Siddiqui

David greenfield.

3 UNSW Simpson Centre for Health Services Research, Sydney, Australia

4 University of New South Wales Southwestern Sydney Clinical School, Liverpool, Australia

Anita Sharma

5 Nepean Blue Mountains Local Health District, Western Sydney, Australia

6 Nepean Clinical School, University of Sydney, Sydney, Australia

Emotional support for patients is critical for achieving person-centered care. However, the literature evidences an ongoing challenge in embedding emotional support within current health services. This study aimed to investigate the strategies to embed emotional support from the perspectives of patients and clinicians. This is an exploratory qualitative study that collected data through focus group discussions (FGDs) and interviews from 11 patients, 2 carers, and 7 clinicians in the multi-disciplinary care teams in an outpatient complex and chronic care setting in New South Wales, Australia. The FGDs and interviews were recorded, transcribed, and thematically analyzed. Three main themes emerged from the experience of both the patients and clinicians: (1) warmth and kindness, (2) deep listening, and (3) social connection in the process of treatment. Clinicians’ and patients’ shared experience of these themes was key to embed emotional support in care. Practical strategies including promoting shared understanding of emotional support, enhancing provider's capability to deliver emotional support, and building patient's networking opportunities in treatment processes were discussed to facilitate emotional support in patient care and health services.

Introduction

Emotional support is recognized as an essential element in safe, high-quality patient and family centered care ( 1 , 2 ). Patient experience is positively enhanced when care encompasses both clinical and emotional aspects ( 3 – 6 ). Emotional support composes 3 components, including: a cognitive understanding of patient needs; an affective imagination of what the patient values; and an altruistic action to alleviate the patient's pain ( 7 , 8 ). A further inherent aspect of emotional support is narrative knowing ( 9 ). That is, shared understanding between the clinician and patient, regarding experience of the chronic disease and feelings such as helplessness and suffering ( 9 ). Additionally, there are other practices to facilitate emotional support such as active listening, empathetic communication, applying relevant therapeutic resources ( 7 , 10 , 11 ), and a trusting relationship ( 8 ).

Health organizations need to provide appropriate structures and processes for staff to deliver emotional support ( 12 , 13 ). To achieve this outcome requires integrating patient centric workplace culture and leadership ( 13 , 14 ), efficient use of resources ( 15 ), provision of staff education ( 16 ), and services knowledge and use of right model of care ( 11 , 17 ). While the requirement for effective emotional support is well established ( 7 , 18 ), the embedding of emotional support in treatment processes is an ongoing challenge for many services. Healthcare organizations should implement the suggestions to embed emotional support as this strategy would improve the patient experience, enhance the effectiveness of services, improve health professional working culture, and prevent the burnout of clinicians ( 5 – 7 , 12 , 13 ).

Emotional care is present in settings, such as psychiatry ( 19 ) and physiotherapy ( 20 ), but there are gaps in other services. Clinicians’ propensity to provide patients with emotional support is influenced by their experience of compassion in the organization ( 21 ) and availability of clinical supervision, which can be variable across service settings and professional groups. A further organizational constraining factor has been the focus on the task of treatment to patients rather than the quality of the therapeutic relationship with patients and ensuring emotional support is embedded in treatment delivery ( 22 , 23 ). Nevertheless, many clinicians value emotional care as it is a professional virtue ( 24 ) that contributes to their psychological vitality and wellbeing ( 21 ). Some experienced medical clinicians provide emotional support, whereas others assess that it is not their role to provide such care, or lack appropriate training to do so ( 25 ). Allied health team members, such as physiotherapists or social workers, are known to have acceptance and capacity to provide emotional support to patients with chronic disease ( 7 , 26 , 27 ). Overall, clinicians report diverse opinions and experience about how emotional support should be provided in clinical settings ( 25 , 28 ), including chronic and complex care ( 1 , 25 , 29 , 30 ).

The patient element of emotional support is best understood through the patient voice, as the perception of the care provided can be different between patients and clinicians ( 31 ). Patients, across chronic care settings, including COPD treatment programs ( 32 ), stroke ( 5 ), mental health ( 22 ), and cancer care ( 33 ), report emotional support as warm, personal, safe and being treated as a human being. Patients highly value clinicians who demonstrate emotional concern for them, including in rehabilitation and recovery phases ( 3 , 7 , 21 ).

How to effectively deliver emotional support deserves greater attention, particularly for patients with chronic and complex diseases. Patients with such conditions present with multi-morbidities, suffering from deteriorating quality of life and emotional wellbeing, and require individualized care plans ( 16 , 33 – 35 ). Understanding the challenges to providing emotional support in the patient journey is crucial for chronic and complex services to be able to: deliver person centered care ( 3 , 5 – 7 ); ensure the well-being of service providers ( 7 , 8 ); prevent staff burnout ( 12 ); and the ethical and value proposition of the health system ( 18 ). Hence, to address this important need and gap, the study aim is to investigate the strategies to embed emotional support in chronic and complex care settings.

Design and Methods

This research was conducted in outpatient services in a tertiary teaching hospital in Western Sydney, NSW, Australia, from May to August 2018. These services, conduct over one million outpatients and community visits each year, incorporating chronic and complex care, including geriatrics, rehabilitation, and chronic pain. Multidisciplinary teams, providing healthcare, include medical and rehabilitation specialists, physiotherapists, and social workers. The study used an exploratory-descriptive research design ( 36 ) with an inductive approach ( 37 ), using focus group discussions (FGD) and interviews ( 36 , 38 ). The team of researchers are experienced clinicians in the chronic and complex care services and academics in the discipline of health services management.

Participants, recruited across the 3 clinical areas comprised 2 cohorts: clinicians and patients with carers or relatives. Potential participants were made aware of the research by email, posters in the clinical area, or verbal invitation by staff. Patients were carefully selected by independent clinician colleagues. Qualitative research literature has drawn meaningful insights from the range of 5 to 25 research participants and the more experienced are the respondents, the lesser number of respondents would suffice ( 39 , 40 ). All the participants had substantial experience with patient care to answer the research question, hence, the recruited number of participants was deemed adequate for this study ( 41 ).

All those invited for the FGD, and interviews agreed to participate in person, in the setting of the outpatient services. All volunteered their time with no renumeration and provided written and verbal consent to participate in the study. Ethics approval was gained from a Human Research Ethics Committee in NSW. The clinicians participated in one group, and patients, families, or carers participated in either a group discussion or an interview. The inclusion criteria for patients were that they were currently attending the chronic and complex outpatient setting during the study period and were English speaking. The exclusion criteria were if the patients had an acute or chronic illness that would limit participation in the study and were a current patient of the first author. The inclusion criteria for carers and families were that they could speak English. The exclusion criteria for family and carers were that if they were a carer for a patient of the primary researcher. The inclusion criteria for clinicians were that if they were currently working at the chronic and complex outpatient service in the study.

The overarching research investigated the 6 patient centered-care domains ( 1 ), including: respect for patient preferences and values; emotional support; information; communication and education about treatment planning; involvement of family and friends throughout the care process; and, coordination of and access to care. This study focused on the domain of emotional support.

A study guide, used to direct interview and group discussions, comprised open ended questions; for example, “Could you tell me about the emotional care you received during treatment?.” Each activity which lasted between 30 and 60 minutes was recorded using an audio recorder and transcribed verbatim, with unique codes used to maintain anonymity, for example: R = patient in rehabilitation, P = patient from other setting, PT = physiotherapist, and D = doctor. Transcription was completed by the first author. Member checking was used with all transcripts offered to participants for review; but no amendments were suggested and made ( 42 ). Data analysis was conducted using thematic analysis ( 37 ). This step-by-step approach of thematic analysis includes 6 non-linear processes which included reading of the manuscripts using a reflective diary followed by coding, then the process of creating themes. The themes in this study related to the domain of emotional support in line with the research question that this paper is addressing. The themes represented the strongest ideas that consistently emerged across the data. The next process was reviewing the themes for authenticity, followed by defining themes. The last process was the drafting and revising the results. Members of the research team (first and second author) discussed the emerging codes and themes. The interim analysis was presented to and reviewed by the whole research team. Points and final phrasing were determined through collaborative discussion and agreement ( 43 ).

There were 20 study participants, comprising approximately 60% patients, 10% carers, and 30% clinicians ( Table 1 ). There were 3 overarching themes: warmth and kindness; deep listening; and social connection in the process of treatment. However, the associated subthemes for the patients and carers differed from those of the clinicians ( Table 2 ).

Participant Details.

Overview of the 3 Themes and Associated Subthemes.

Warmth and Kindness

The first key theme was warmth and kindness. Patients explained this experience in three interrelated ways. Firstly, patients commented how the personal attributes of clinicians such as a friendly manner facilitated the therapeutic relationship. They described clinicians in friendly, engaging ways, including that the psychologist was “approachable” (P1) and the physiotherapy staff in the rehabilitation gym were “warm and personal” (P2). Secondly, it was the “sense of being known.” One patient stated that she developed, over a 2-year period, a close interpersonal connection with the treating physiotherapist who now “knew and cared for her” and that “they (the clinicians) sense when I am not ok” (R2). Another patient also stated that they too had become friends with their therapists during treatment (R1). Thirdly, patients witnessed staff extending acts of kindness to patients. Physiotherapy staff were observed in the hydrotherapy pool providing careful, attentive, intensive support to patients who had severe disabilities. This was illustrated by the comments: “Staff concentrated on the ones that needed the help” and “made sure we were all right” (P4).

Clinicians described warmth and kindness, as essential for recovery in care, and encompassed 2 elements. First, the necessity to build trust, and second, the intention to build a positive therapeutic relationship. Together they were considered key to emotional support and the foundation in the patient journey. A clinician stated the point “you need to build that trust and rapport first and then it [the therapy] is easy” (PT4). Kindness was a motivating factor for clinicians in supporting patients and building a therapeutic relationship, as reflected by: “I want to make a positive influence in their life” (PT1) and “I want the therapeutic relationship to be positive” (PT4). Another clinician talked about the need to persevere with patients whose mood was grumpy when they initially attended treatment. They explained how to use a warm and engaging manner to address barriers to therapeutic relationship, that is:

They’re the patients I really like to work with because it's a challenge for me and that where I get the positive kind of feedback or that feeling when you finally crack that really grumpy 94-year-old man that just doesn't want a bar of you. When you find something, you just see the change straight away, that's what I enjoy (PT2).

Deep Listening

The second key theme was deep listening. Patients explained this experience as follows: firstly, patients reported the importance of experiencing being listened to in the interaction with the clinicians. One patient summarized the positive experience as “(the) doctor really sat and listened ” (PF1). Being heard assisted them to engage and participate in treatment. Patients reported that in most consultations, the clinicians were able to mindfully listen to them. Secondly, they explained that listening was important to develop trust within the therapeutic relationship motivating them to engage and adhere to the treatment plan, even when struggling physically or emotionally. One example of this was demonstrated when a patient said “they all listened. I was really impressed so I thought-yep-right well go with it” (PF1). Following this experience the patient enrolled in and completed a falls prevention program. Conversely, patients reported when, on occasion, the clinician was distracted and did not listen they felt distressed, irritated and there was a sense of emotional disconnection with the clinician.

Clinicians spoke about the necessity of listening to patients as the first step to engaging them in therapy and healing. They explained “listening is the basis of everything” (PT3) and “we listen to the patient … (because) …the patient wants to express how they feel” (PT1). There was consensus that an emotional connection must commence at the initial consultation. One doctor, reflecting the view of her colleagues, said her treatment methodology was to use “respectful engagement” involving the family, reporting: “… (I) talk to them (the patients), be respectful, and also then include the relatives into the conversations” (D1). Clinicians suggested practical ways to improve connection with patients and families, including asking about the patient's pets (PT2) or using humor to improve patient engagement, particularly when the patient seemed depressed (PT1). Additionally, the focus for clinicians was to discover what mattered to the patients by listening intently. Clinicians reported that successful treatment was achieved when they focused first on the patients concerns—be that social, pain or sleep issues—and then they undertook their assessments for cognition or functional ability. As one clinician explained: “(I) listened to the main complaint. They (the patients) may be coming to my clinic for cognitive impairment, but they say I’ve got a sore arm” (D1).

Social Connection in the Process of Treatment

Patients spoke about 2 elements facilitating the social connection in the treatment process. They first discussed how they valued the opportunity of sharing the lived experience of having a chronic illness with others. This social opportunity created by the treatment program—either at the physiotherapy gym, chronic pain service or the hydrotherapy pool—enabled conversations concerning the major challenges of having a chronic illness, thus, gaining and giving emotional support to each other. One patient from the chronic pain service explained this experience: “I’m surprised, because I haven't experienced that in the past, just talking to other people who have similar problems. I think that's really important” (P4). He suggested that there should be more group programs to manage chronic pain conditions to facilitate this peer support. The second element was that patients who attended the weekly physiotherapy program or the hydrotherapy pool reported that they formed new friendships. This was important to patients, because they were experiencing social isolation. A patient reflected on the physiotherapy rehabilitation gym at the hospital which she attended weekly stating “it's a supportive environment, I became friends with other patients here” and “it's a community environment” (R1). A confirmation of this theme of the social, emotional connection was noted at another rehabilitation venue as a patient reported “I met so many nice people at the hydrotherapy pool” and “once a month we go out and have coffee after we have been to the (hydrotherapy) pool” (P5).

The clinicians’ view confirmed that social supports were important for the patients, particularly with the geriatric population who live alone with chronic and complex illnesses. A clinician affirmed this idea explaining that “strong social supports and social networks were essential, so the patient is in a much better position to deal with ageing” (PT2). There was general agreement with this premise by the clinician FGD: they stated a positive dynamic became established; that is, patients who managed the chronic and complex disease in positive ways, had strong social connections, which led to better emotional wellbeing, enabling them to manage their health better.

This study has established that in the setting of chronic and complex outpatient care, emotional support encompasses 3 elements: (1) warmth and kindness; (2) deep listening; and (3) social connection in the process of treatment. Additionally, the study makes a unique contribution in evidencing that a shared understanding of the experience of these 3 elements between the clinicians and patients is the key to embed emotional support in care. Hence, emotional support is simultaneously a simple, complex, and essential domain of person-centered care to support high quality patient health outcomes ( 7 ). “Warmth and kindness,” a key component of emotional care, is the clinician engaging the patient with warm interested personal interactions ( 11 ). Deep listening, which aligns with narrative knowing, is how the clinician develops an understanding of the individual's experience of their health issues and resultant physical, emotional, and psychological distresses ( 9 ). Together these actions facilitate a strong therapeutic relationship, a collaborative communication style between clinician and patient ( 44 ), and enhance adherence to treatment plans, and improved outcomes ( 9 , 45 , 46 ). A further, significant dimension to enhance the care process and outcomes was identified: social connection in the process of treatment. Patients sharing the lived experience of having a chronic illness, formed new friendships, gaining and providing emotional support. This activity is a highly effective strategy to drive improvements and aligns with the current practice of shared medical appointments ( 47 ). Patient networking is a psychosocial activity for managing chronic illness that can reduce isolation, promote shared understanding, and build resilience despite their health challenges ( 48 ). The flow on impact of social connection in treatment is increase in positive health outcomes for patients ( 49 ).

Implications

The findings of this study imply the need for 3 strategies to effectively embed emotional support in chronic and complex care. The first strategy is for the organization to promote shared understanding of emotional support between clinicians and patients. There is a lack of understanding of the necessity of emotional support by clinicians and education is required to ensure a common understanding exists ( 50 ). The education is a precondition for the practice of effective emotional support in an organization. This would include processes, for example, using patient feedback to develop shared understanding between patients and clinicians ( 50 ) and ensuring that an appointment has a consultation time of extended length to allow for in-depth communication between the clinician and the patient. The second strategy is for the health service to enhance the provider's capability for emotional support. This would include emotional support champions who are necessary to advocate, encourage, support, and guide colleagues to master this skill in practice ( 47 ). In addition, managers who encourage staff to bring the best of themselves to patient care are vital to join the team of champions to embed practice of emotional support as an organizational value ( 51 , 52 ). A final recommendation to support this strategy is clinician education for deep listening via organizational programs such as narrative supervision groups and Schwartz rounds, making uncaring behavior from staff burnout less likely ( 53 , 54 ). The third strategy is that networking opportunities during treatment, provided by not only clinicians but also via peer support, should be a norm for patients as it improves care outcomes and the patient experience. Health services, when possible, can combine the compassionate care provided by staff and facilitate connection between patients enabling a sharing of the lived experience of chronic illnesses ( 47 ).

Limitations

The study limitation is that it was based at one site, involving a modest number of participants. There was possibly unintended selection bias in the study due to the inclusion and exclusion criteria. If the study is replicated, then the inclusion of a randomized design would overcome this issue. Nevertheless, the research has provided a window into a challenging but important dimension of clinical practice. Further research is recommended in other locations, service types and different professions to continue emotional support knowledge and practice evidence development.

Emotional support, in chronic and complex settings, comprises warmth and kindness, deep listening and social connection during treatment. Emotional support is a challenging but essential component of the way healthcare services should, and can, be delivered. But, in practice, emotional support is recognized as a challenge for organizations and clinicians to implement and maintain. Systemic, multifocal, and comprehensive strategies that address the patient needs can embed emotional support and achieve enhanced clinical outcomes for patients and satisfying work for clinicians.

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The authors received no financial support for the research, authorship, and/or publication of this article.

Ethical Approval: Approval was gained from the NBMLHD Human Research Ethics Committee, NSW.

ORCID iD: Jane Bradshaw https://orcid.org/0000-0001-9657-0101

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The Importance of Making Time to Really Listen to Your Patients

Rana L.A. Awdish, MD | Leonard L. Berry, PhD | Harvard Business Review

October 13, 2017

The Importance of Making Time to Really Listen to Your Patients - Banner Image

Actively listening conveys respect for a patient’s self-knowledge and builds trust, and allows physicians to assume the role of trusted intermediary.

Modern medicine’s healing potential depends on a resource that is being systematically depleted: the time and capacity to truly listen to patients. Some health professionals claim that workload and other factors have compressed medical encounters to a point that genuine conversation with patients is no longer possible or practical. We disagree.

Actively listening to patients conveys respect for their self-knowledge and builds trust. It allows physicians to assume the role of the trusted intermediary. It is only through shared knowledge that physicians and patients can co-create an authentic, viable care plan.

Medicine that doesn’t make time for active listening poses real risks. Clinicians may mistakenly provide ineffective or undesired treatment, or miss pertinent information. All of this serves to diminish the joy of serving patients, thereby contributing to high rates of physician burnout. These consequences have clear human and financial costs.

When a doctor and a patient join forces they can dismantle harmful hierarchies. Each is forced to rely on his or her partner, because neither has access to all the relevant data.

In their medical training, physicians are often taught to maintain a clinical distance and an even temperament. They are warned not to get too close to patients, lest they internalize the suffering and shoulder it themselves.

Patients learn roles, too: Adhere to the doctor’s plan, squelch errant thoughts that might sound foolish, don’t ask too many questions, defer to the expert, be “a good patient.”

In a complex, fraught situation such as a serious illness, people need a compassionate guide — a wise, comforting Sherpa who knows the mountain, the risks of various routes, the viable contingency plans. This physician-Sherpa should be a partner on the journey, not simply a medical operative.

Health systems must invest in organizational cultures that value the patient’s voice. Organizations can do this by inviting physicians to share patient stories during meetings or by convening patient advisory-board meetings with practice leaders to explore ways to improve patient experiences.

Medicine is constantly evolving as new ways emerge to treat, heal and cure. We must continually reflect on the changes, and correct the course as needed. This work cannot happen in a vacuum of forced efficiency. Physicians, patients and administrators all must maintain and build on what is sacred and soulful in clinical practice.

Rana L.A. Awdish, MD, is the director of the pulmonary hypertension program at Henry Ford Hospital and the medical director of care experience for the Henry Ford Health System in Michigan. Leonard L. Berry, PhD, holds the M.B. Zale chair in retailing and marketing leadership at Texas A&M University’s Mays Business School.

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Wait, just a second, is your doctor listening?

The researchers analyzed the initial few minutes of consultations between 112 patients and their doctors. These encounters were videotaped in various US clinics during training sessions for doctors. In their analyses, Singh Ospina and her colleagues noted whether, for instance, doctors invited patients to set the agenda through opening questions such as "How are you?" or "What can I do for you?" The researchers also recorded whether patients were interrupted when answering such questions, and in what manner.

She acknowledges that the frequency of interruptions not only depends on the type of practice being visited, but also relates to the complexity of each patient.

"Our results suggest that we are far from achieving patient-centered care," she says.

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Materials provided by Springer . Note: Content may be edited for style and length.

Journal Reference :

Naykky Singh Ospina, Kari A. Phillips, Rene Rodriguez-Gutierrez, Ana Castaneda-Guarderas, Michael R. Gionfriddo, Megan E. Branda, Victor M. Montori. Eliciting the Patient’s Agenda- Secondary Analysis of Recorded Clinical Encounters . Journal of General Internal Medicine , 2018; DOI: 10.1007/s11606-018-4540-5

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How to Advocate for Yourself at Doctor’s Visits, According to Doctors

W ith a limited amount of allotted time and a pressing health matter to discuss, a trip to the doctor’s office can sometimes feel like a high-stakes event. Even the most routine visits can leave you feeling dissatisfied if there’s a communication barrier, too many items on the agenda, or a personality clash.

Research shows that people who are able to vocalize their medical needs tend to be happier with their health care experiences and are even more likely to see improvements in symptoms and other important outcomes. So how can patients become better advocates for themselves and help take charge of their health in the process? We asked physicians for their best tips and strategic advice to help ensure your next doctor’s appointment goes as smoothly as possible.

Write down your concerns before the visit

Dr. Michael Albert, chief of internal medicine with Johns Hopkins Community Physicians in Odenton, Md., says he understands what patients can be up against when they go to see their doctor. First, there’s the inherent power balance between doctor and patient, which he says is slowly changing as medical schools begin to focus more on patient-centered care, but remains a problem. And he’s heard more than his share of stories over the years of physicians who appear to lack empathy when a patient raises concerns. “We know we need to do better as physicians,” Albert says.

Some of that disconnect comes down to time pressures, which can make physicians feel rushed to find a “fix” for their patients, rather than validating their feelings, Albert says.

Read More : Long Waits, Short Appointments, Huge Bills: U.S. Health Care Is Causing Patient Burnout

To counteract that, he advises all patients to write a list of their concerns in order of urgency to help ensure that their voice is heard in the appointment. It doesn’t need to be an exhaustive narrative; in fact, being brief is key to keeping the appointment on track. But people who come prepared with a note highlighting main points they want to discuss often make better use of their limited time with the doctor. “Then we can really dig into the things that are most important,” he says.

By the time patients reach sub-specialist Dr. Kathryn Mills, they’ve usually already interacted with numerous physicians and other care providers. Mills, a gynecologic oncologist and assistant professor of obstetrics and gynecology at University of Chicago Medicine, says it can be confusing and overwhelming for patients to navigate the system, which is why she encourages them to write down their questions in advance.

“It is hard, when you get in that moment, to remember everything that you wanted to have addressed,” says Mills.

Send a portal message the day before

When a concise written list won’t suffice—such as when a patient wants to provide contextual information about a complicated injury—Albert says sending an electronic message through a patient portal the day before an appointment can help prepare the doctor. Some insurance plans have begun paying doctors for responding to portal messages, which incentivizes doctors to communicate with patients.

Just don’t expect doctors to respond to complex questions through portal communication, Albert says. Those issues are best addressed in person.

Craft an “opening statement”

Doctors always face time constraints and are usually juggling multiple demands, Albert says. To help foster a strong relationship, he often advises patients to start their appointments with a brief opening statement that highlights their reason for coming in while acknowledging the doctor’s hectic schedule.

And the little things, such as showing up on time and making sure your paperwork is filled out, can go a long way toward building the provider-patient relationship, Mills says. When patients are on time and prepared, doctors are better able to stick to their schedule and spend the appointment focused on the issues at hand.

Google your symptoms—yes, really

Doctors rarely advise patients to fall down a rabbit hole online. But that doesn’t mean you shouldn’t do research. The best patient is the informed patient, according to Dr. Benita Petri-Pickstone, a family physician in Gahanna, Ohio and clinical assistant professor of family and community medicine at the Ohio State University Wexner Medical Center in Columbus. She says a vital aspect of self-advocacy is for patients to take an active role in their health, which means doing their research ahead of time so they can ask informed questions. Be proactive, raise any concerns with your doctor, and don’t hesitate to ask a multitude of questions, she says.

Read More : 6 Compliments That Land Every Time

“The patient who tends to get the better care is usually one that is more vocal and asks informed questions about things based on what they’ve read and based on symptoms that they are feeling,” Petri-Pickstone says.

Bring someone to your appointment

In situations where people may not be able to advocate for themselves, such as seniors who are experiencing a cognitive decline, Petri-Pickstone encourages them to bring along a trusted friend or family member. “I’m always open to having spouses and children come in with the patient to help give a good history so I can find out the total picture about what’s happening,” she says.

Seek a second opinion

When patients are experiencing doubt or appear to be uneasy, Mills encourages them to seek a second opinion. Mills often sees patients who are coming to her for one, and she believes it’s a critical step people can take to advocate for themselves and ensure they are getting the right care.

She says that sometimes, patients don’t want to tell her they are in her office to seek a second opinion because they’re afraid it will color her opinion. But Mills says she believes it better serves patients if they are transparent and speak about the specific concerns that prompted them to seek the advice of another physician. “It sets the stage in a different way,” she says.

Don’t hesitate to find new care

Sometimes, the relationship between a doctor and patient just isn’t the right fit, Albert says. If someone has tried everything and the doctor is impossible to understand or just doesn’t listen, it might be time to seek another provider, he says. “They should select somebody who they feel more comfortable with,” he says.

The ideal doctor-patient relationship will vary depending on a person’s needs. But in general, people should be able to have a back-and-forth discussion with their physician and feel like their concerns are being heard and addressed, Albert says. If people feel like their doctor is going to listen, it becomes much easier for them to advocate for what they need.

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Listening Full Test 2
Listening Full Test 2 -b Section 4. 3373. By IELTS Practice Online. 00:00. 00:00. I've been doing some research into what people in Britain think of doctors, the ones who work in general practice - the first call for me medical care - and comparing this with the situation in a couple of the countries. I want to talk about the rationale ...
Research on questions about doctors
Research on questions about doctors IELTS LISTENING SECTION-4
The importance of physician listening from the patients' perspective
Results. Patients explained why listening was important to them and these findings were organized into three themes: (a) listening as an essential component of clinical data gathering and diagnosis; (b) listening as a healing and therapeutic agent; and (c) listening as a means of fostering and strengthening the doctor-patient relationship.
When Patients Don't Feel Heard By Their Doctor
It totally is. If you don't feel like you can trust your health care provider—that they're not listening to you or not competent—or if you aren't 100% certain they have your best interests at heart, you may not feel confident in following their advice. Our research has shown that people who feel they don't have a good relationship ...
Assessing effective physician-patient communication skills: "Are you
Patients commonly complain that physicians do not listen to them. "Being a good doctor requires not only knowledge and technical skills, but also communication" [ 1 ]. Communication skills are not just restricted to talking, but also to listening and nonverbal communication [ 2 ]. Assessment of the provider's ability to apply ...
PDF Research on questions about doctors
SECTION 4 Questions 31-40 . Questions 31-36 . Choose the correct letter, A, B. or . C. Research on questions about doctors . 31 . In order to set up her research programme, Shona got . A. advice from personal friends in other countries. B. help from students in- other countries. C. information from her tutor's contacts in other countries. 32
How can Doctors Improve their Communication Skills?
Formal training of the doctors in improving communication skills is necessary and has proven to improve overall outcome. The authors recommend inclusion of formal training in communication skills in medical curriculum and training of practising doctors in the form of CMEs and CPEs. Keywords: Breaking bad news, Doctor patients conflict, Verbal ...
IELTS Practice Test
IELTS Listening Practice Elite IELTS PrepListening SectionTopic: Research on Questions About DoctorsContent:Listening Questions 31-40Sources:Elite IELTS Prep...
PDF Patient Education and Counseling
listening as the primary deﬁning feature of a good doctor. A typical response to the question, 'How would you describe the qualities of a good doctor?' was: ''I would say a good doctor is somebody who will listen to what the problem is and explain to you what it is and what is being done.'' Although the research protocol
Teaching Doctors To Be Better Listeners : NPR
Our number: 800-989-8255. If you're on Twitter, you can tweet us. Write the @ sign followed by scifri, S-C-I-F-R-I. Alan Schwartz is an associate professor and director of research in the ...
Listening Beyond Auscultating: A Quality Initiative to Improve
INTRODUCTION. Physician communication is foundational to patient care and has been shown to impact patient satisfaction, adherence to treatment plans, and health outcomes.1 The Kalamazoo consensus statement, put forth by leaders of major medical organizations and academic institutions on core criteria for effective physician patient communication, emphasized building the physician-patient ...
cambridge ielts 8 listening test 2 answers
Section - 4 Research on questions about doctors. Answer Key for Research on questions about doctors Listening Test. 31. B 32. B 33. A 34. A 35. C. 36. C 37. B 38. F 39. D 40. C.
IELTS Listening Multiple Choice Questions in Section 4
IELTS Listening Multiple Choice questions (MCQs) consist of 3 choices, so are easier than Reading. Section 4 is usually made up of gapfill questions, but multiple choice questions are also common. Thank you for your interest in my IELTS lessons and tips. Come and join the Bronze Membership to access this fabulous lesson and lots more.
The relationship between Empathy and listening styles is complex
Background Effective communication is the key to a successful relationship between doctors and their patients. Empathy facilitates effective communication, but physicians vary in their ability to empathize with patients. Listening styles are a potential source of this difference. We aimed to assess empathy and listening styles among medical students and whether students with certain listening ...
Listening in Health Care
Summary Effective listening is a fundamental component in safe, quality health care provision. In health care contexts, listening constitutes both an art and science. ... The chapter highlights a number of areas where future research is needed to enhance the existing knowledge base. References, , & (). . , , - ...
Wait, just a second, is your doctor listening?
She led research that investigated the clinical encounters between doctors and their patients, how the conversation between them starts, and whether patients are able to set the agenda. The study is in the Journal of General Internal Medicine which is the official journal of the Society of General Internal Medicine and is published by Springer.
Cambridge 08
The player one is for listening Part A and the player two is for listening Part BClick the players and start listening: ... Cambridge 08 - IELTS listening test 02 Section4:Research on Doctors. Click the player and start listening ... Current Page 1 Page 2 Complete 31 In order to set up her research programme, Shona got. A advice from personal ...
Perceptions of Doctors' Empathy and Patients' Subjective
with their health perceptions after a meeting at an online clinic and whether experiences of empathy could be enhanced by augmenting an automated anamnesis questionnaire completed before the visit. Methods A total of 209 adult patients agreed to participate in the study. First 103 patients filled out the regular version of the questionnaire (June-August 2019) and then 106 filled out the ...
Wait, just a second, is your doctor listening
She led research that investigated the clinical encounters between doctors and their patients, how the conversation between them starts, and whether patients are able to set the agenda.
Kindness, Listening, and Connection: Patient and Clinician Key
Introduction. Emotional support is recognized as an essential element in safe, high-quality patient and family centered care (1,2).Patient experience is positively enhanced when care encompasses both clinical and emotional aspects (3-6).Emotional support composes 3 components, including: a cognitive understanding of patient needs; an affective imagination of what the patient values; and an ...
The Importance of Making Time to Really Listen to Your Patients
Actively listening conveys respect for a patient's self-knowledge and builds trust, and allows physicians to assume the role of trusted intermediary. Modern medicine's healing potential depends on a resource that is being systematically depleted: the time and capacity to truly listen to patients. Some health professionals claim that ...
Wait, just a second, is your doctor listening?
Aug. 20, 2020 —. May 21, 2019 —. On average, patients get about 11 seconds to explain the reasons for their visit before they are interrupted by their doctors. Also, only one in three doctors ...
How to Advocate for Yourself at Doctor's Visits
Seek a second opinion. When patients are experiencing doubt or appear to be uneasy, Mills encourages them to seek a second opinion. Mills often sees patients who are coming to her for one, and she ...
Listening to the patient, the essential step to patient care
Listening to the patient, the essential step to patient care. The doctorpatient relationship is an important aspect of medical practice, the researchers were interested in exploring these essential issues to improve communications with patients for many years. 1, 2, 3. Looking to and concentrating all the consultation time on the lab results ...

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Original Source

Kindness, Listening, and Connection: Patient and Clinician Key Requirements for Emotional Support in Chronic and Complex Care

Nazlee Siddiqui

Anita Sharma

Introduction

Design and Methods

Warmth and Kindness

Deep Listening

Social Connection in the Process of Treatment

Implications

Limitations

The Importance of Making Time to Really Listen to Your Patients

Recommended Reading

Career & Learning

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How to Advocate for Yourself at Doctor’s Visits, According to Doctors

Write down your concerns before the visit

Send a portal message the day before

Craft an “opening statement”

Google your symptoms—yes, really

Bring someone to your appointment

Seek a second opinion

Don’t hesitate to find new care

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Listening Full Test 2 - Section 4