“Recognise what is running through your own mind and then clear away this clutter to make room to hear the other person.” – Oscar Trimboli

The profound advice from Oscar Trimboli on deep listening should resonate with healthcare professionals. The practice of deep listening extends beyond merely hearing the words of your clients; it involves an immersive experience where you engage fully, not just with the spoken narrative, but with the unspoken messages conveyed through body language, tone, and emotion. 

In the context of healthcare, the ability to listen deeply holds the key to an accurate diagnosis and other problems beyond the diagnosis. 

It is possible to fall prey to diagnostic bias, where your preconceived notions and internal monologue cloud your judgment. This bias can lead to a tunnel vision approach to diagnosis, where you seek only the evidence that confirms your initial assumptions, rather than exploring all potential causes of a patient’s distress.

The Pitfalls of Diagnostic Bias

Imagine a scenario where a patient presents with persistent knee pain. Based on a quick preliminary assessment and your previous experiences, you might lean towards a diagnosis of patello-femoral pain syndrome. With this assumption at the forefront, you might inadvertently direct your questioning and examination to confirm this hypothesis, potentially overlooking other conditions such as referred pain from the hip or lumbar spine, meniscal injuries, or non musculoskeletal issues.

This bias not only limits your diagnostic capabilities but can also lead to ineffective treatment plans, prolonged recovery, and dissatisfaction from your clients.

Examples from a Physiotherapist’s Perspective

This example is a personal one from many years ago. A friend and former basketball team mate had been seeing her local doctor and physiotherapist for over 6 months for what they had diagnosed as patello-femoral pain.

She came to see me even though it took her over an hour to drive to my practice because she was frustrated by her lack of progress and wanted to get back to playing basketball. As I went through her history it became clear to me that it was possible that her pain was not MSK in nature. She’d had a history of breast cancer eight years previously and had been cleared of any cancer but I wasn’t convinced that the presenting pain was related to her knee.

I was concerned and asked her to see one of the top sports doctors in Adelaide at the time which she agreed to do. Unfortunately her cancer had returned in the form of metastatic bone cancer and I was extremely sad to hear that she had passed away within 3 months of seeing me.

This experienced reinforced for me the importance of great questions, listening and being aware of diagnostic bias.

Exercises to Develop Deep Listening Skills During Consultations

To ensure you remain present and open to your patients’ narratives, here are some practical strategies to self-recognise and manage mental clutter during consultations:

• Pause Technique: Implement regular pauses during the consultation to check in with your thoughts. After the patient has shared information, take a brief moment of silence to digest what has been said and to clear any preconceived notions. This deliberate pause can help maintain focus and prevent premature conclusions.

• Thought Noting: When you notice unrelated thoughts or assumptions creeping in, mentally note them as ‘thinking’ and gently redirect your attention back to the patient. This technique comes from mindfulness practices and helps to acknowledge distractions without engaging with them.

• Clarification and Paraphrasing: If you find your thoughts diverging, engage in clarification. Repeat back to the patient what they’ve said in your own words to ensure understanding. This not only confirms the accuracy of the information but also refocuses your mind on the patient’s concerns.

• Patient Narratives: Encourage your patients to tell their story without interruption. This narrative approach not only makes the patient feel heard but can also reveal key insights that may not emerge from direct questioning alone.

• Open-Ended Questions: Challenge yourself to ask open-ended questions that don’t fit within your initial diagnostic hypothesis. This encourages a broader perspective and allows the patient to provide information that may lead to a more accurate diagnosis.

In conclusion, as health care clinicians, your ability to listen deeply is paramount. It not only fosters a more accurate diagnosis but also builds trust and rapport with your patients. 

By incorporating deep listening into your practice, you can better serve your patients and enhance the quality of care you provide. Remember, every patient carries their own unique story, and it is your privilege to listen to it in its entirety.

Contact me to find out when I’m coming to your state for communication skills workshops: annettetonkin@gmail.com