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QuotationMarkLeft.png Listen to the patient, he is telling you the diagnosis QuotationMarkRight.pngWilliam Osler 1904 (possibly after Jean-Martin Charcot (died 1893)

One of the consulting skills is listening. Clinicians are regrettably less than excellent at it, commonly giving in to the urge to interrupt and move to a directed interview after an average of only 18 of the 600 seconds allocated to contain a typical GP consultation (according to a 1984 paper in Annals of Internal Medicine).

Active Listening

Listening is not simply a passive process, or rather it can be, but providing some interaction aimed at encouraging the patient to tell a story and continue to do so is superior.

A collection of techniques of conversation are recognised for this purpose (and do not count as interruptions). Body language is useful in that there is no competition for bandwidth on the audio channel, but still imposes a cognitive load on the speaker.

Reflecting back ("and then it all went wrong ..."), rehearsing ("You said that you began to get pains low down ..."), making encouraging grunts ("uhuh") and in general reacting to what it is said with the appearance of being interested assist the flow.

Despite deploying all these, hardly anyone talks for more than 120 seconds before pausing and listening in their turn.

Stopping Listening (and acting)

Sometimes the clinician must stop the story and redirect it, or indeed bring it to a halt in order to present a formulation of the main problem and follow it up, or very occasionally in the hope of being able to go home that night.

Listen to the Exit Line

"While I am here doctor" , said with the hand on the door after the apparent resolution of one or several presenting problems, is commonly of immense significance. Sometimes you must call them back, sit them down, and follow that up. Sometimes you can dispose of it, need merely note it, or should ask them to come back tomorrow or next week in order to deal with it in a sufficiently long time period. But you must react.

Category: Communication skills