Monday, August 23, 2010


For one of our classes we have to write "personal development essays". While rushed and somewhat BSed it still provides some insight into my inner musings. Plus one of my classmates posted her's, leaving me to think "why not?". So, this is my first one of 2nd year:

As a child my parents made sure to teach my brother and I the difference between “listening” and “hearing”. According to them, listening was a passive act that held little meaning and respect. Instead of having us listen, they wanted us to hear what was being said. They wanted us to be actively engaged in dialogue and to put effort in to ensure mutual understanding. Their distinction introduced us to the value of not spacing out while listening to someone, not interrupting, or otherwise being inconsiderate in conversation.

Later on, through group facilitating experience I was introduced to the idea of active listening. While I have learned that there are many ways to do this, one of the most meaningful ways I have experienced involves having one person speak for a set period of time while the other(s) remains totally silence. When the speaker has said all that they have to say, they end their session by saying “I have spoken”; the other person(s) respond by saying “I had heard” and nothing else, never responding to what was said. Then it is the other partner’s turn to speak. This interaction tends to feel very unnatural and uncomfortable at first, but manages to create an extraordinary safe space for significant interactions to occur. There is a shared trust that a scared space has been created, and that you have as long as you need to process what you are saying while you are saying it. In theory listening to others should be an intrinsic ability yet activities such as these make me feel that it is much more of an acquired skill.

I guess that I should not be surprised that truly listening is a challenge. We live in a world where we are constantly on the go, constantly multi-tasking, and being completely self-consumed with our own lives. Our society appears to no longer values face-to-face conversation (at least outwardly), having instead replaced it with the instant gratification of e-mail, text messages, and cell phone conversations. The problem with these forms of communication is the difficulty in staying actively engaged, and the ability to misinterpret what the other is saying. I have more than one string of e-mails turn sour due to misinterpreted words, leading to more e-mails in order to rectify the situation.

The culture of medicine seems to add even more difficult to listening. From day one in medical school we begin learning a new language, one that is efficient, relatively exact, and completely foreign to the majority of our patients. We are also taught the importance of time management; learning early on that time is limited and valuable. While many of us have the best of intentions, these lessons can easily put distance between us and our patients. Leading us, their doctors, to ask questions without waiting for answers, correct their statements with authoritative-knowledge, and dismiss their concerns with our lack of time. While we many think that we are listening to our patients with the 15 minutes we have for a visit, we are never doing it for more than a few seconds at a time and we certainly are not hearing what they are telling us.

Through my work at the student clinic(s) I am already starting to sense how easy it is to feel rushed and inpatient during visits with our patients. When I ask a question such as “have you have a TB test before?” and get a long winded response, it takes effort to not interrupt to ask “yes or no?” However, the tiny bit of effort that it takes to bite my tongue produces valuable awards: the privilege of hearing personal stories and a better understanding of my patients. I hope that throughout my medical career, especially when feeling overwhelmed, I remember the value in active listening. The valuable lesson to strive beyond listening, to work to hear, is one I will carry with me throughout my career and will hopefully play into all my future.

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