By Cynthia Ackrill, MD
You are right in the middle of a conversation…and suddenly you realize you have followed your own thoughts down some pathway so far that you have no earthly idea what the other person just said. Maybe you are still forming a rebuttal to a statement 4 sentences ago, or maybe you are thinking 5 steps ahead about your idea. Or perhaps you are processing some emotion that bubbled up from your subconscious when she mentioned a sticky quality review issue, or you realized that you don’t even know about this issue. Or you really just sidetracked wondering if you remembered to take your extra key fob out the pants you dropped off at the cleaners.
Whatever the case… now you have to scramble and choose whether to admit you were not listening, or use one of the well-rehearsed filler statements to buy some time to catch on and look like you knew what was going on all along.
Despite our best intentions—to be present, attentive, focused, open, curious, collaborative listeners—in the reality of our busy, stressful, competitive, failure-phobic world, so often we miss the mark. And the result is extremely costly! Poor listening skills waste time, efficiency, opportunities, brilliance, profits, and the feeling of connection missed by so many. Communication failures risk quality of care and patient satisfaction. Truth be told, it greatly erodes our own satisfaction. When we are so busy-brained, we miss chances to shift perspectives, learn from the wisdom of others, get creative, see new solutions, or feel deeply connected.
Is this unique to healthcare? Of course not, but there are some aspects of the healthcare culture that reinforce a less receptive, risk-avoidant mental stance. Reared in a system where the acquisition of knowledge is revered and rewarded, “knowing” can become the goal at the expense of cognitive flexibility, openness, and emotional intelligence. True, the risk of “not knowing” in medicine can be critical to patient outcome, but somehow this competitive culture supports a state described in some disciplines as “already-always-knowing.”
I can remember to this day being on rounds down the hall from my general surgeon ex-husband as he was reprimanded for not speaking with force… whether he knew the right answer or not! Heaven forbid, we show vulnerability or admit we might not know something!
Sure, we are taught to listen to the patient, observe body language, and be attuned to soft clues, but even then, the point is to be “in the know.” In our heads we are spinning through differential diagnosis internal dialogues, trying to fit what the patient says into our puzzle. (And reportedly, we are so busy weaving our own thoughts that we interrupt within 7 seconds!) This is not the style of listening needed for effective influence, engagement, leadership, or the deeply satisfying connection to people and purpose so many crave.
Yet it is a style we have trained so well, it becomes our fallback under any type of stress. 360 evaluations of physicians in leadership development programs often reveal a need to learn to listen more openly, with less judgment and more vulnerability. This is what builds the trust and engagement needed to heal healthcare. Listening with more curiosity than attachment allows the brain to find more possibilities, make new connections, and find collaborative solutions that value and engage others. This is the substance of leadership presence and influence.
But how do you do that? You are sleep-deprived, need quick solutions, and your iPhone is reminding you that you are late to clinic. Everybody wants a part of you, and your head spins with your never-ending to-do list. You have to actually disrupt your busy internal dialogue to mindfully shift to more “active listening” in the moment. Whenever possible, take a breath before a conversation and decide HOW you want to listen. You can create and practice a habit of disruption. This is mindfulness in action! There is amazing power in choosing how to be present and think, instead of staying in reactive mode.
I have had some coaches train themselves to take a breath as they go through each door and choose their present focus. Others put a tiny dot on their computers, phones, steering wheels, and doorways reminding them to breath and choose. There are lots of techniques. Just play with one and practice with curiosity and self-compassion—it’s a learning process. Breathe.
Does this matter? YES!! As healthcare shifts and physicians want to take a more active role in leadership, the art of listening is critical to building influence. Vulnerability is a key leadership attribute. (See Quiet Leadership or the HBR blog, “What Bosses Gain By Being Vulnerable.”)
Repeat a “mantra” like “present and curious” or whatever inspires your intention
Picture your mind actually opening up to receive
Picture your attention or energy settling down in your core (heart or gut) instead of in your spinning head. (Feel your feet on the ground?)
Check your assumptions, expectations, competition, and judgment at the door ;-)!
Don’t assume you are getting all the other person is trying to communicate or that they are receiving your intended thoughts
Rephrase/reflect what you just heard—“I hear you saying that ….”
Ask for clarification of what they said and whatthey heard
Ask questions that acknowledge what you just heard
Whenever you can choose a question over a statement
Pause more & Interrupt less
Avoid words that raise defenses
Accept that communication is often difficult and requires not only delivering information, but making sure it landed, and that you actively received as well.
If you need time for a more intelligent or thoughtful response, ask for it. “Let me think about that for a bit and I’ll get back to you by the end of day.” (Then do!)
Don’t assume that you know what the other person is talking about
Curiously enjoy the opportunity to connect in some way and advance learning
But I believe it matters even more immediately, to each and every one of us. Humans thrive through connection. Constantly navigating the changing seas of healthcare, too many physicians feel disconnected from their values and their whys, from their loved ones, each other, and the greater community. Active listening is a way back. When we listen more actively, we connect more deeply, think more broadly, and feel more engaged in our own lives. Get curious and play with it?