Tell Me a Story: The Importance of Listening vs. Hearing

Do you ever think about the privilege that our patients give us when they entrust us with their stories? Or the privilege that we have as a profession of having the TIME to listen? I know that is something that I have lost sight of at times, whether it’s due to the busy-ness of a crowded schedule, my own biases (SURE, you have a high pain tolerance…), or other stressors or things that make me feel too busy to sit and listen.

I think the privilege part of this has become more and more apparent to me as I have begun to work with individuals with pelvic floor dysfunction. Suddenly, I became the healthcare provider who was trusted to engage in a dialogue with them about intimate details of their lives, and whose responsibility it was to ask them detailed questions about their sexual experiences or bathroom habits. When I first trained to treat pelvic floor dysfunction, I was nervous; how would people feel if I suddenly started asking them these very intimate questions? Would they think it was weird that their physical therapist wanted to talk in detail about their sexual, bathroom, or birth experiences?

What I found-much to my surprise, to be honest-was that patients not only accepted my questions, but welcomed them, and the floodgates of information opened. In fact, they were thrilled to discover a healthcare provider with whom they could discuss these topics and find knowledge, answers, and compassionate troubleshooting. Many of them have told me that they have spent more time talking with me than with all of their other healthcare providers combined in the year up until that point.

Even if you don’t work with patients with pelvic floor dysfunction and don’t need to get quite as detailed in your questioning about these topics (though I would contend that you should still screen these functions!), you are still being trusted with your patient’s story. Even if this is your 452nd low back pain patient this year, this is the one and only back that Mary Sue has ever had-and maybe her first experience where a provider has sat and listened carefully and attentively to her symptoms. I know it can be easy to start thinking “Oh yes, I know what is going on, because I have seen so many of these patients this year”-this is your opportunity to make a huge difference with THIS patient, and it starts with careful listening and smart questions. Whether doctors should take better histories or not is a whole other can of worms that we could open, but what it boils down to is: you can’t assume that this patient has had a comprehensive history (or physical exam!), and you have the privilege and opportunity to provide this important first step in patient buy in.

One of the things I was told as a student has continued to stick with me throughout the years: “Listen to your patients, they will tell you what is wrong with them.” I have certainly found this true in my years of practice! And how many times have you heard repeated the refrain, “I told my doctor XYZ but he/she didn’t believe me/didn’t listen to me.” It is sad that this is the expectation of our healthcare system-that the provider may or may not listen and certainly won’t take into consideration the chief complaint of the patient! Now of course, there is a balance here somewhere; we do have to be efficient with our time as well.

What are some of the ways that you personally have found to be helpful for really getting deep into patient’s stories in the amount of time you have, and truly listening, not just to what you expect to hear, but also to what the person is actually saying? Have you found any helpful “resets” for yourself when you start to get into the cynical headspace that says “I know this person’s story, it’s the same as the stories for the last 10 people I evaluated with this diagnosis”?

10 responses to “Tell Me a Story: The Importance of Listening vs. Hearing

  1. What a super post! Jennifer has given all financially struggling private practice PTs (as well as those whose vision needs renewing) some keys to success. Success is really about the patient therapist relationship that is developed from Day One.
    Your in depth evaluation the first day, wherein you begin by asking open ended questions and then listen, listen, listen and respond reflectively.

    Slow down their commentary with closed end personal questions and then reset the eval as you wish. Great stuff Jennifer!!

    1. Jennifer Stone says:

      Thanks for your comment! I think your comment to respond reflectively is spot on. Not only does that make people feel you are listening closely to them, it really can help you ensure that you understand what they are trying to say! And if patients believe that you took that time to make the personal connection with them, they are much more likely to adhere to your suggestions.

  2. Mark Salamon says:

    Great article on a great topic. Nothing drives me more crazy than hearing “I told my last therapist it was making it worse, and they kept telling me to do it anyway”. What helps me really listen is imagining that it is me sitting there telling that story. Would I want to be interrupted? Let them tell the whole story. If they go off on an unrelated tangent, wait for a pause and interrupt with a relevant question about their situation instead of lecturing them to stay on subject. And continue this throughout their treatment. Nothing makes a patient know that you are really listening more than adjusting their treatment when they tell you that things aren’t working.

    1. Jennifer Stone says:

      Excellent point, Mark! And what an opportunity for us to really show off our expertise (adjusting treatment to the individual patient instead of just mindlessly going through a routine of exercises) and really provide professional, high quality, SKILLED care. I know it can be easy to go into autopilot, but that is such a disservice to our patients and profession. Thank you for your caring work with patients, I can “hear” your compassion through this comment!

  3. Keith Roper says:

    Wonderful post, Jennifer. There is nothing more effective to establish a strong therapeutic alliance than to genuinely LISTEN to your patients story. I have, for years, used the exact same line that, “if you just listen to your patient (give them a chance), they will tell you what is wrong” but we too often jump in too quickly, and miss the best part of the story.
    I agree with Jim that this is a key tool for successful practice, no matter what your setting. Human intuition is powerful and your patients know when you are really listening to them.
    I have had the honor of having some remarkable stories shared with me through my years of practice, and I have found that both my outcomes and my job satisfaction are improved when I genuinely hear my patients story.
    I sometimes don’t get my full physical exam done on a first visit if I think the story is important enough. I will get enough information and do enough of an exam to send them home with some specific advice and homework, and will tell them I am sorry we ran out of time today, but that I felt their story was so important that I wanted to hear it and we can complete any additional testing needed on our next visit. It is powerful to tell patients that what they have to say was is important.
    Thanks again for a thoughtful post.

    1. Jennifer Stone says:

      Keith,
      Thank you so much for sharing these wonderful insights! I love that you pointed out that it is okay to not get 100% of your physical exam done on day 1-this is a key point that I try to get across to students and new therapists that I mentor. I truly believe that so much of the benefit of physical therapy is in the therapeutic relationship that we establish with our patients-and listening (especially reflective listening) is one of the easiest and fastest ways to establish that. I also think that when you do this really well the first few visits, you lay the groundwork to be able to help people re frame their experience if needed (therapeutic neuroscience education, etc.) because they KNOW that you are listening and you value and validate their experiences, where if you don’t do a good job of that, it is easy for them to feel that you are blowing it off or saying it is all in their heads. Keep up the great work, we need more therapists like you!

  4. Robert Wainner says:

    Jennifer,

    Great post on what is clearly a foundation for clinical excellence.

    Also, a great reminder of the pitfalls of “fortune telling” or “mindreading” thought traps. Besides the fact none of us have those abilities, true active listening, just like the clinical exam, has it’s own inherent therapeutic value.

    1. Jennifer Stone says:

      Thanks, Rob! You are one of the mentors who taught me the most about the value and importance of listening, so thank you!

  5. Sharna prasad says:

    Excellent article thank you. Loved all the comments, it is so nice to hear these comments from my peers. I loved the comment of not finishing the whole eval on the first visit. It is so critical to truly listen to our patients as yes if we listen they will tell us what’s wrong with them, but if we wait and listen further they will tell us how to treat them. It’s through Empathy, education and empowerment that we as a profession will Transform society, and optimize movement. We as a profession are a sleeping giant (David Butler’s words). Once we collectively wake up we can make such a huge difference in Healthcare. In the meantime we just keep on doing our share individually. We are so privileged to be a part of our patients lives and their stories. Thanks.

    1. Jennifer Stone says:

      Sharna, I very much appreciate your thoughts as well! We are so uniquely poised to really have a positive impact on our patients and I love how many therapists have really seemed to take ownership of this concept. Keep up the great work!

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