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Listening skills for physician executives.


"The Sperry Corporation discovered both business and personal relationships, the consequence of inadequate listening are extraordinarily costly. Simple listening mistakes cost the business world millions of dollars annually." [1]

It is not easy to listen. We would all rather be the center of attention doing all the talking. This is not a terribly bad fact. It is just a fact. But if we do not learn to take turns, if we do not learn to listen, we will not have friends, we will not have a chance of being truly heard ourselves, and we will not know what is really going on in our organizations.

Extroverts probably have the hardest time listening, because they like to do their thinking by talking about what they are hearing. They want to process the information they are listening to out loud. Introverts want to process the information internally in quiet, so they have an easier time of keeping themselves from talking.

Listening is easier if you like what you are hearing, but you may be asked to listen to topics you don't want to hear about. The marketing department may tell you that customers want evening hours, chiropractors, optometrists, or midwives. The finance department wants you to hear the details of the budget--not just that the organization is in the black or red. Nurses may complain to you about other physicians. Administrators want you to get physicians to spend less money, and the physicians want you to get administrators to understand what procedures are necessary to give patients high-quality care.

If listening is so hard, why bother? "A fatter paycheck, closer friendships, a smoother running marriage, building ties of trust with your children, and becoming generally more successful can be some of the results of attentive listening." [2]

Most people have heard of "Parent Effectiveness Training" and the active listening that it recommends. Active listening has gotten some bad press because people have overused the term "I her what you are saying." If someone is rampaging, and I say, "You seem to be angry," a natural response might be, "You're damned right I'm angry." Active listening is a good technique, but how and when you use it needs to vary if you do not want to further alienate the person you are talking to.

"Active listening involves a restatement of either the message or the feeling of the speaker without giving advice, analyzing, or probing." [3] It is the place to begin when listening to someone with a problem. You do not want to quickly interrupt and say "I know how you feel" or give advice. But you do not want to overdo active listening either, because the listener may feel that you are acting like a parrot or a robot.

Listening is an art that starts with attentive silence. When my children were younger, if I did not look at them when they talked to me, they would say, "Turn your face, Mama." Shortly after they could talk, they knew I had to be looking at them to really be paying attention. Adults know this, too, whethr they tell you or not. It's your job to hold your eyes and body so that they know you are paying attention.

Young children talk, a lot so when I couldn't listen anymore, I said so and told them I would listen more later. We need to deal with adults in the same way. If you cannot pay attention, say so, and let them know when you'll be available to listen.

Try not to make a habit of pretending to listen when you are not, particularly in a one-on-one situation. People will come to distrust you. However, all of us have been in long meetings when listening simply was not in us anymore. At that point, pretending to listen is better than throwing your arms back with a deep sigh or closing your eyes in a bored slouch. Such behavior has a negative effect on those who may still be paying attention.

Listening is hard work. "While an average speech rate for many people is about 200 words per minute, most of us can think about four times that speed. With all that extra think time, the ineffective listener lets his mind wander. His brain takes excursions to review the events of yesterday, or plan tomorrow, or solve a business problem...or 'sleep.'" [4] You have to work to control your mind and make it concentrate on what is being said. If you are troubled by an impending malpractice suit, a divorce, or a child who is having problems, your capacity to listen will diminish drastically. You will need to be patient with yourself in those circumstances and perhaps tell the person that you are distracted and ask for a repeat of the information.

Milo Frank said he asked a group of people how long they could pay attention to what someone was saying without letting their minds wander off to sex, money, or the other good things in life. He got "answers of anywhere from four hours to four seconds. [5] Listening takes enormous energy and discipline.

If you decide you are willing to expend the energy to listen, here are some techniques that will help you listen so people will want to talk to you and will value you as a person who helps them solve problems.

Be quiet. You cannot be listening if you are talking or if you are thinking hard about what you are going to say next. If you get very anxious about now knowing what to say when the person finishes, try putting all your energy into listening and then tell him or her, "I need to think about this. Can I get back with you in a while to talk more?"

Roger Aleis, who coached President Bush during the 1988 presidentail campaign, suggests that you should listen carefully before all interactions, particularly ones where you are scheduled to make a presentation. "When you enter a communication situation, don't immediately stand up and start projecting your voice and throwing out your opinions. Stop for a second, absorb what's going on. What's the mood of the room, the crowd--are they down, up, happt, expectant? Read what people are feeding back to you. Are they skeptical or eager?" [6] The only way to find this out is to be quiet and listen.

Use your body to let the person know you are there. Look at him or her. Don't let your eyes wander all over the room. Sit attentively but not tensely, not slouching or lying down. On the sofe watching television or reading the paper are not good positions for listening. Neither is opening your mail in your office while someone tries to tell you something. You may think you can do both, but the talker does not think you are listening and will be irritated.

Given an occasional "uh huh" or nod to let the talker know you are following his or her train of thought. If you are not, ask a question before you let the person go on too long, and you are really lost.

Ask nonjudgmental questions. "Can you say a little more? I'm not sure I understand. Will you try me again?" Don't ask, "Why on earth did you do that?" There is absolutely no decent answer to that question, and the person doing the asking is implying, "You are an idiot!" You may right, but if you want communication to continue, you will have to discipline yourself not to say everything you think.

Good listening requires asking timely questions that help the person along with the story. "Think of the people you know whom you consider to be true leaders. When you are with them, they invariably ask questions. They are interested in you and your ideas. They are also interested in improving their listening skills...." [7]

Restate some of what the person has said to demonstrate that you understand. This is not necessary in every situation, because sometimes questions that ask for more information let the person know you are with them.

Make a guess about a feeling you think the person is having if it seems appropriate. It doesn't matter if you are wrong. They will correct you, and you have gotten to a deeper level of communication when you find out how someone feels about a subject. They will feel a sense of relief and sometimes release when they identify the feeling.

Listening becomes even tougher when people are angry. Sometimes people come to your office obviously upset. If you are feeling strong and collected, it is helpful if you can let the emotional person vent for a few moments. You might then respond, "I can see that you are angry and I'm not surprised. What can I do to help?" If you are not up to being in the presence of so much negative energy, you might say, "I'll be glad to talk about this when you are calmer."

I'm going to ask you not to do three things early in the listening process:

* Don't give advice.

* Don't pass judgment.

* Don't tell your own experience.

As a physician executive, you are paid to give advice and pass judgment, but it's a matter of timing. We want to do these three behaviors quickly. Save them for last, after you have let the person talk for a while.

The administrative part of your job may demand that you advise a co-worker that someone needs to be fired or that you deny a request for a type of surgery, but try not to get in a habit of firing off what needs to be done so quickly that you don't listen carefully enough to people.

In personal relationships, the listener's experience can be quite valued by the talker. If I'm going through a divorce and you've lived through one and are happy now, I want to know how you did it, when the pain got better. But if I'm telling you my problem, I don't want you to quickly turn the conversation back around to you and what you have been through that was worse.

Talking can be a healing process. We often avoid people who have had some trauma, who are very sick, or who have lost a loved one, because we think we don't know what to say. You don't have to say anything except that you are sorry and then listen. People can begin to heal if they can talk about their pain. Verbalizing it releases some of it.

In the clinical setting, listening skills can convey to the patient that you have stayed with them longer than you actually have. If a patient wants you to listen for 20 minutes and you only have 10, you can prepare them for the interaction so they don't feel rushed. First, let them talk. Ask them how they are doing. When they say, "Poorly," say, "I'm sorry." Then let them talk for a least a minute without interrupting them. If this is difficult for you, put a clock where you can see it. They may want to talk about what happened in 1946--that may be the last good memory they have, so let them talk a minute. Then say in a caring tone of voice, "I have about 10 questions I need to ask you to find out how I can help you. I'll ask one and when I've heard what I need to know, I'm going to ask you to stop and we'll move to the next one. I'll be listening very carefully even if I seem to be hurrying you through the questions. I'll be taking a few notes." Sit down if possible and look at them often while you ask the questions and listen.

In spite of all the suggestions I've made, what if you are an exdtreme extrovert who thinks it will be almost impossible for you not to think out loud. Prepare your listener for that fact: "I'll need to process what you are saying by talking some myself. I'll probably ask you lots of questions and may need to stop you so I can talk about what you said, but I am going to give you time to say everything you want to say." People respond better to you if you tell them in advance how you are going to proceed.

Changing listening habits is tough. Anytime you try to change a behavior, you . . ." will run afoul of existing, entrenched forces which will protest and resist." [8] You will need techniques to constantly remind you. Pinch your hand, bite your tongue, put 3 x 5 cards with reminder messages where you can see them. Learn a relaxation technique so you can train yourself to breathe deeply and concentrate rather than jumping into a conversation too quickly. Sometimes, you can make yourself listen because you want to be thought of as doing your job well, and you don't want to be embarrassed by being caught not listening. Other times, that does not provide enough of a cattle prod effect. In those situations, pretend that you will learn something valuable from this person even if you think otherwise. Or, if you know that is impossible, think of yourself as giving a humanitarian gift to someone else. All of us need to give of ourselves in some way. If you don't have time to serve in the soup kitchen for the homeless, give some charitable gifts of listening to those around you.

Carlyle Marney, a noted theologian, wrote in The Recovery of the person, "This is the sovereign grace of God in persons that a man can be heard through anything, and once he has been heard he is really never again as if he had not been heard." [9] People who have been carefully listened to perform better in the workplace and lead more productive lives, because they feel valued.

Barbara J. Linney is Director of Career Development, American College of Physician Executives, Tampa, Fla.


[1] Swets, P. The Art of Talking So That People Will Listen. Englewood Cliffs, N.J.: Prentice-Hall, Inc., 1983, p. 40.

[2] Conklin, R. How to Get people to Do Things. New York, N.Y.: Ballantine Books, 1979, p. 84.

[3] Carr, J. Communicating and Relating. Menlo Park, Calif.: Benjamin/Cummings Publishing Co., Inc., 1979, p. 152.

[4] Swets, P., op. cit., p. 42.

[5] Frank, O. How to Get Your Point Across in 30 Seconds-or Less. New York, N.Y.: Simon and Schuster, 1986, p. 15.

[6] Ailes, R. You Are The Message. Homewood, Ill.: Dow Jones-Irwin, 1988, p. 39.

[7] Bethel, S. Making a Difference, 12 Qualities That Make You a Leader. New York, N.Y.: Berkley Books, 1990, p. 205.

[8] Wheelis, A. How People Change. New York, N.Y.: Harper Colophon Books, 1973, pp. 158.
COPYRIGHT 1992 American College of Physician Executives
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Author:Linney, Barbara J.
Publication:Physician Executive
Date:Jan 1, 1992
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