All types of communication involve the sending and receiving of a message, which must be encoded by the sender, and decoded by the receiver if it is to have meaning.

The skill of listening demands that you are prepared to acknowledge your patient’s point of view first and foremost. That doesn’t mean you have to agree with it, but at the very least, be curious about your patient’s perspective.

During a conversation, your patient has a message to communicate and its meaning is encoded in words, often imperfectly.

When in a conversation with patients you might choose to reflect what they’ve said. You can use reflective listening, at any time during your consultation, to clarify meaning. This is particularly important when dealing with patients who have either complicated or chronic conditions.

There are two types of reflective listening: ‘simple reflections’ and ‘complex reflections’.

Simple Reflections

Simple reflective listening involves repeating what the patient has said. You can do this in two ways – in the form of a statement or in the form of a question. The only difference between the two is that a question ends with an upward inflection.

Here are some examples:

“You can’t do this exercise”

“You can’t do this exercise?”

“You don’t have time to fit exercises in”

“You don’t have time to fit exercises in?”

“You don’t understand exactly what you need to do”

“You don’t understand exactly what you need to do?”

To hear the difference between making a statement and asking a question, try speaking them aloud.

To avoid defensiveness from a patient, it’s usually best to respond with a statement. A question requires a response, which can place undue demands on the patient. Avoid that unless, of course, that’s what you are aiming for.

A statement encourages the patient to explore the comment further. It is often followed by information that can give you a better understanding of what’s holding the patient back.

You certainly wouldn’t respond in this way to every statement the patient made; that would sound silly.

Complex Reflections

Complex reflective listening involves hearing what the patient has said and making a guess as to what that might mean. This is about interpretation, rather than merely repeating what the patient has said.

You would use this to move a conversation forward and facilitate understanding.

Here are examples of complex reflections.

Patient:          “I’m feeling pretty down today”

Therapist:      “Something has happened since you were last here”

            or        “Things haven’t gone so well over the last week”          

            or        “You look like you’re in a bit of pain today”

It’s important not to make too big a guess as to what a person means. If you do you’ll often see it in the patient’s response.

With both simple and complex reflective listening the aim is to create empathy and show that you’re listening to your patient.

What Constitutes Attentive Listening?

Attentive listening is one of the most important skills you can develop, especially when dealing with challenging patients.

Attentive listening is a skill just like the other clinical skills you have. It’s very easy to start thinking about the next question you’re going to ask while your patient is still answering the current question. This is NOT attentive listening.

Attentive listening means that information gathering is at the top of your agenda; it’s the primary goal of your interaction with a patient. And that’s because you need to have a full clinical picture in order to help your patient in the best possible way.

When you’re dealing with unmotivated patients, or those managing chronic injury or illness, and looking for the best way help them, your main aim is to discover what’s preventing them from getting better treatment outcomes.

If previous treatments had helped them, or if they were managing their condition effectively, it’s unlikely these patients would come to see you – unless they were there for maintenance treatment.

Your patients are often telling you more than the words they are using. It’s important to listen for the gems of information that will make your intervention more effective than those they’ve had in the past.

Listen with more than your ears

Listening with your ears is self-explanatory. There is also non-verbal listening.

What constitutes non-verbal listening?

• Giving undivided attention. Doing two or more things at the same time is not providing undivided attention.
• Maintaining consistent eye contact on the part of the listener. The speaker often looks away while talking; this is normal. Always be aware of cultural sensitivities to eye contact.
• Facial expression. It’s normal to mirror each other’s emotional expression during a conversation. It signals listening, understanding and joining. An exception to this would be the expression of anger.

Do you give your patients undivided attention? Are you comfortable with eye contact? Do you mirror some of the emotions of your patient or do you have more of a ‘poker face’?

Improved listening skills will be invaluable when you are managing challenging patients, and engaging in potentially difficult conversations. They are also skills that will help you keep patients, and have them feel they are important to you.

To learn more about motivational tools through effective communication download my eBook

“Improving Patient Motivation In Physiotherapy”

I wrote this eBook in response to the most common question I get asked and that is “How do I motivate my patients?”

If you would like to fine-tune your communication skills when working with resistant patients, you might consider working with a coach or mentor.

Or perhaps your staff would benefit from training in this area.

Contact us, and find out more about what we can offer you.

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