The power of listening.

Communication is a two-sided coin. On one side are behaviors that are designed to have someone understand your message. The agenda is yours and the target is someone else. We can label these behaviors "push" behaviors, because they are designed to push your thoughts or feelings toward someone else. On the other side of the coin are behaviors that are designed for you to again a better understanding of what another person is thinking or feeling. The agenda is the other person's and the target is you. We can label this second set of behaviors "pull" behaviors, because they are designed for you to pull thoughts or feelings from another person.

The fax machine can function as an analogy. I insert my message into the fax and transmit it to you. In effect, I am pushing my thoughts or feelings toward you. The agenda is mine and the target is you. This is an electronic version of push behavior. On the other hand, if I ask you to fax me your thoughts or feelings on something, I would be pulling them from you. The agenda would be yours and the target is me.

Physicians have a built-in bias in favor of push behaviors:

* Physician-Patient Encounter: "Cheryl, your throat is red. The lymph nodes in your neck are swollen and tender. A throat culture shows beta strep. You have a strep throat. I want you to take this antibiotic for one week."

* Physician Administrator-Colleague Encounter: "Doctor Mint, you have 15 unfinished charts on your desk. I expect them to be completed by tomorrow morning."

* Physician-Nurse Encounter: "I have a real sick patient in the hospital. Cancel all my afternoon patients."

* Physician-Spouse Encounter: "The office has been a zoo today, and I'm running late. I can't make it for dinner, and I'll be home late."

The common thread among all these conversations is the physician's pushing his or her thoughts or feelings toward someone else. It not only becomes a behavioral habit, but also is supported by a belief that the quickest way to effectively communicate is to push your message toward someone. If the only tool you have is push behaviors, every encounter you face looks like an opportunity to use push behaviors.

There is nothing wrong, or ineffective, with push behaviors, except when this behavioral muscle is so overdeveloped that you no longer can use pull behaviors if situations warrant them. Witness the heated exchange between two physician "pushers" over the unfair distribution of income. They are both operating with the same push behaviors and neither is listening to the other. Communication is not complete unless there is a sender and a receiver. In this example, as in many others, there are two senders. The image that comes to mind is the crash of two big horn sheep.

The underlying message these examples send out is that, when the communication scale is heavily tilted toward push behaviors, the communication process can become very unbalanced. Pull behaviors really narrow down to listening skill and the enormous, undeveloped potential for the power of listening in organizational and personal relationships. The balance of pushing our messages to other people and taking the time to listen to what they are thinking or feeling has a major bearing on how we participate in and enjoy the many relationships we have, in both our professional world and our personal world.

Attentive listening is at the core of all pull behaviors. It is different from our usual mode of listening. Often, we are so busy formulating our replies or mentally wandering off in our own thoughts that we do not listen very attentively. We are pushing our thoughts or feelings toward someone rather than gaining a better understanding of their thoughts, ideas, or feelings. Often enough, it is because we really have not heard them.

Attentive listening occurs at two levels:

* Listening to another person when he or she delivers a piece of information and manifesting that you are listening through some verbal or nonverbal indicator.

* Listening to another person after you have delivered a message to them. This level of listening can be manifested by asking the other person how he or she feels or thinks about what you just said.

Physicians are supposed to be good listeners. "Listen closely to the patient; they will frequently tell you the diagnosis." Good advice! You're then programmed quite early in training to ignore this advice and instead are taught to focus on the patient's chief complaint. Think back to when you were a medical student, intern, or resident enduring morning rounds. "Listen to the patient's heart in room 203 for a good example of aortic insufficiency." "Leroy is a great case of liver failure." "403 is eclamptic." Concentration on the chief complaint became part of your make up. Recent reports indicate that new patients, on average, are interrupted by the physician within 18 seconds of their first utterance. Triage mentality says, "find the chief complaint, pigeon hole it, and get on to prescribing." It is no wonder that listening becomes an underworked, underdeveloped behavioral muscle! Pushing our messages is one of the most overworked behavioral muscles in our repertoire.

Our communication behaviors are like any other muscle group. If we do not use a muscle very often, it will grow weak and inefficient. It is no surprise that the quality of communication in relationships may not be reaching its full potential. In the past 10 years, there has been an abundance of anecdotal evidence to indicate that one of the primary contributors to the demise of relationships is the feeling by one if not both parties that they have not been understood by the other party. Think about a problem relationship you may have and ask yourself if there is a correlation between the quality of that relationship and the extent to which you believe you are understood by the other person.

You would think that, with the majority of physicians and administrators having such well-developed push behavioral muscles, most, if not all, communication problems would have been solved by now. What often occurs in a training program we conduct at the College's National Institute ("Building Organizational Cooperation: The ABCs of Win-Win Relationships) is a startling insight on the part of participants that listening is at least as effective as pushing. Gaining a better understanding of what the other person is thinking or feeling can provide a host of benefits to the person who is normally doing the pushing.

* It is possible that you may gather information about what is going on with the other person. When you use the push side of the equation, you can do so with more efficacy and sensitivity.

* Gaining a better understanding tells the other person that he or she is important enough to listen to. When you are seeking organizational cooperation, a colleague who feels listened to will be more likely to understand and support the message you are sending.

* Listening can become a reciprocal process. If you want to increase the probability of someone's listening to what you have to say, you may want to start listening to what that person has to say.